What is Limb Reconstruction?
Limb Reconstruction can be defined as that branch of Orthopaedic Surgery concerned with achieving maximum function from a limb deformed as a result of either a congenital or acquired condition or trauma. The techniques involved include Limb Equalisation, Correction of Angular and Rotational deformities, Correction of Mal and Non-Unions, Epiphyseodesis, Arthrodiatasis and Joint Reconstruction. Mr Khan is involved with Limb Reconstruction and is an internationally renowned expert in the field; with exceptional knowledge with the techniques of Limb Lengthening and Bone Transport, the use of internal and external fixators and intramedullary devices. The principles of bone and soft tissue regeneration under conditions of distraction are employed.
Types of Limb Reconstruction Conditions
There are various reasons why patients present to the Limb Reconstruction Team for advice or treatment.
Some of the more common conditions include:
Who is a candidate for Limb Reconstruction Surgery?
Patients who are candidates include those who have undergone surgery to remove a tumor, patients with a failed healing of a fracture and those who have suffered a traumatic injury to an extremity.
Who may benefit from Treatment?
People who may benefit from treatment include:
Patients with limb length discrepancies, as the result of:
A poorly Healed Fracture
Patients who are at risk of amputation owing to missing bone tissue, lost from an infection, trauma or tumour.
What are the risks of Limb Reconstruction Surgery?
All precautions to ensure patient safety are taken prior to every operation. However, as with any surgery, some risks remain. For example, there is the possibility of infection, excessive blood loss and the development of blood clots. The incidence of these risks occurring in patients is very small.
Over time, some joint replacements, metal plates, screws or rods can loosen and require revision. This risk occurs infrequently because of better patient selection, surgical techniques and improved implanted materials.
How long is Limb Reconstruction Surgery?
The duration of Limb Reconstruction Surgery depends on the type of operation being performed and the amount of Reconstruction required. Surgery can last from two to eight hours. Mr Khan is a internationally recognised expert in the field and is highly regarded. You will be well cared for during your operation by your anesthesiologist.
How is Limb Reconstruction Surgery Performed?
Surgery (Osteotomy): The process begins with an operation called an Osteotomy, in which the Mr Khan cuts the bone to be lengthened. The limb (usually the upper or lower leg) is then stabilised using one of several different external and/or internal fixation devices or frames.
Treatment Phase 1: In the first, or distraction phase, the bone that has been cut is very gradually pulled apart, in a process that promotes distraction Osteogenesis, or new bone growth, at the site of the Osteotomy.
Continued growth of new bone tissue is accomplished by adjusting nuts and bolts in the frame. Generally the rate of correction is 1 mm per day but there are variations.
As the space between the ends of the bone opens up, the body continues to produce new tissue in the gap until the desired length of bone has been generated. The new bone formed initially is soft, and does not show up on X-rays. It gains strength gradually.
Additional adjustments may be made to the fixation devices to correct any deformity that may be present, such as a misalignment of the bone resulting from trauma.
Treatment Phase 2: During the second phase of treatment the bone consolidates and heals. The patient gradually puts more weight on the affected limb, and starts walking without crutches.
X-rays confirm when the new bone is completely healed. The fixation device is then removed and the patient may function normally.
In patients with Cancer, the Orthopedic Surgeon will remove the tumour and a margin of normal tissue surrounding it, then reconstruct the bone and/or joint using the patient's own bone or bone from a donor. If necessary, a specialized modular joint replacement may be used. The bone is stabilized using metal plates, rods and screws.
The specialized team performing surgery includes a vascular surgeon to help rebuild the circulatory system and Mr Khan who specializes in microvascular surgery and muscle transfer.
Mr Khan will discuss the Reconstructive Surgery you are having.
Recovery after Limb Reconstruction Surgery
The length of rehabilitation will depend on the type of surgery performed and the patient's own functional status. Normally, rehabilitation after limb reconstructive surgery can take anywhere from six weeks to six months. Most patients will regain full function and a normal lifestyle.
Pain is a subjective experience. Every patient will have different coping mechanisms and different tolerances to pain, and all treatments are slightly different with varying difficulties for the patient to cope with.
Patients in Ilizarov Fixation will nearly always require analgesia during their frame treatment time.
Some patients require high doses of Morphia (or equivalent drug) towards the last third of the adjustment period, gradually reducing off the analgesia following completion of the frame adjustments. Whilst the patient is in hospital they are taught about what level of pain they should expect to happen during their frame treatment time and the usual progression of that pain.
What is a External Fixator?
The External Fixation device may be used for other purposes as well as securing the unstable bone. It may be used for Limb Lengthening or correcting Bony Deformity.
The Ilizarov Fixator is a circular frame that surrounds the limb. It may have a combination of wire pins and thicker pins called half pins. It can be used in a variety of different ways to perform a variety of functions. It may be used to correct a deformed limb. It may be used to mend a fracture or lengthen a short limb or correct a bony deformity. It may be used to increase the blood circulation to the limb.
The advantage of the Ilizarov Frame is that it can be used to do all of the above at the same time.
What are Wire Pin’s?
These are narrow lengths of stainless steel wire that go through the bone and soft tissues of the limb. These wires are attached on each side of the external rings of the Ilizarov Fixator under high tension and then secured.
What are Half Pin’s?
These are stainless steel pins which are secured into one side of the bone. These pins are thicker than the wire pins and are only attached on one side of the frame. These are used when a higher strength of fixation is required.
What is a Monolateral Fixator?
The Mono-lateral Fixator is a fixator device that is applied along the limb, not around the limb.
It can be used for a variety of conditions. It may be used to mend a fractured limb or lengthen a limb. It is composed only of half pins. The principles of limb lengthening are the same as for the Ilizarov Fixator, but the method differs. With the Mono-lateral fixator a tool called an Allen Key is used to make the frame adjustments.
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