A conceptual framework for soft tissue management of transdermal bone-anchored implants in extremity prostheses

Soft tissue complications are among the most common reasons for revision surgery following transdermal, bone-anchored osseointegration. While many orthopaedic surgeons are familiar and experienced with the use of intramedullary implants, the soft tissue management surrounding a percutaneous and permanent implant in continuity with the outside environment remains a challenging problem. With this in mind, we present our rationale and a framework for soft tissue considerations in preparation for bone-anchored osseointegration based on early experiences with most commercially available osseointegration systems.