What is limb reconstruction?
Limb reconstruction is the set of surgical techniques used to restore normality as far as possible to a limb that has suffered a serious trauma, as a result of which there is a loss of normal function or anatomical loss of bone and soft tissue. Most of these interventions can be performed under loco-regional anesthesia.
Why is it performed?
To restore normality to a limb affected by sequelae of severe trauma or surgical complications that cause loss of function or anatomy. It is performed to recover the best function and anatomy closer to normal, to avoid angulations and shortening of limbs.
What does it consist of?
It consists of the reconstruction of a bone fragment at the expense of the residual bone to be reconstructed. Schematically it consists of the creation of a fracture in the bone to be reconstructed, the new bone regeneration is achieved in the “stretching” of the reparative callus, thus generating a new bone in continuity with the patient’s bone, hypervascularized bone, morphologically identical to the bone of origin and with the same characteristics of mechanical resistance, a normal and “own” bone.
Preparation for limb reconstruction
The limb must be free of infectious processes, so any existing septic process must be treated as radically as possible beforehand. To perform the reconstruction, external fixation systems (transporters) are used to control from the outside of the limb the displacement of the bone fragments used in the reconstruction, “stretched fragments” in bone transportation. Occasionally the technique can be performed with specially designed endomedullary nails.
Post-operative care
Once the Reconstruction System has been installed and the transportation (stretching) of the bone fragments has begun, the limb must remain unloaded during the “active” phase. In this phase a new soft regeneration is produced by stretching of the fracture repair callus, which must be protected from the load. Once completed, the “static” phase begins, that phase in which the regenerate “matures” and ossifies. When the degree of ossification allows it, the patient can support the limb. During the whole process, the cutaneous entry holes of the skeletal fixation “screws”, which join the bone to the external device, must be meticulously taken care of.