Soft-Tissue Contouring and Nerve Management During Lower-Limb Osseointegration Surgery

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Rehabilitation Medicine

Background:

• Osseointegration provides a direct prosthesis interface for lower-limb amputees, bypassing traditional socket issues.
• Skeletally anchored implants reduce skin-related complications like breakdown, ulceration, and pain.
• Effective soft-tissue contouring and peripheral nerve management are crucial for successful osseointegration.

Purpose of the Study:

• To describe a surgical technique for single-stage lower-limb osseointegration.
• To detail methods for soft-tissue contouring and peripheral nerve management.
• To optimize outcomes and patient satisfaction in osseointegration procedures.

Main Methods:

• Mobilizing anterior and posterior musculature for bone-implant coverage.
• Performing targeted muscle reinnervation (TMR) and potentially regenerative peripheral nerve interface (RPNI) for nerve management.
• Excising redundant tissue, creating a posterior skin flap, and establishing a skin aperture for prosthesis attachment.

Main Results:

• The technique aims to cover the bone-implant interface without excess tissue.
• Nerve management techniques (TMR/RPNI) are employed to mitigate neuroma formation and pain.
• Careful skin aperture tension is maintained to prevent necrosis and infection while allowing drainage.

Conclusions:

• Osseointegration is a safe and effective option for lower-limb amputees, improving mobility and quality of life.
• The described surgical technique addresses critical soft-tissue and nerve management aspects.
• While complications like infection and neuroma can occur, they are manageable with appropriate surgical techniques and postoperative care.