Marano Andrew A, Modiri Omeed, Rozbruch S Robert, Otterburn David M
New York-Presbyterian Hospital/Columbia University Medical Center, Division of Plastic and Reconstructive Surgery.
Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S33-S36. doi: 10.1097/SAP.0000000000002329.
Patients with lower extremity amputations using a classic socket prosthesis face many challenges related to the socket-limb interface. The adaptation of osseointegration has allowed for the attachment of a prosthesis directly to bone, eliminating this interface and providing mechanical benefits. Contrary to the socket prosthesis, the osseointegrated prosthesis requires reducing and minimizing the soft tissue envelope. Studies have shown that patients who have undergone placement of these implants have high rates of reoperation for soft tissue redundancy. The purpose of our study was to evaluate complication rates and need for revisional surgery using our technique of soft tissue closure around the prosthesis at the time of implant placement.
An institutional review board-approved, retrospective chart review was performed on all patients who underwent implantation of an osseointegrated prosthesis for lower extremity amputation with concomitant plastic surgery closure at our institution during a 2-year period from June 2017 to June 2019. Patient demographics, health status descriptors, operative data, length of admission, and rates of postoperative complications were gathered from the electronic medical record and coded into a HIPAA-compliant database. Specific outcomes tracked included minor and major infection, osteomyelitis, implant failure, hematoma, seroma, delayed wound healing, and rates of reoperation and readmission.
There were a total of 14 patients who underwent osseointegrated implant placement with concomitant plastic surgical coverage of the prosthesis during the study period. The average patient age was 50 years (range, 26-70 years), and average body mass index was 32.2 kg/m (range, 19.7-44.8 kg/m). Average follow-up time was 28 weeks (range, 10-73 weeks). There were 2 cases of local infection resolved with a course of oral antibiotics. There were no instances of infection requiring procedural intervention or hospital admission, nor any cases of osteomyelitis. Two patients required outpatient surgery for exchange of implant abutment, one required revision of a prosthesis for hardware loosening, and one required targeted muscle reinnervation of a sciatic nerve neuroma. There were no patients who required revisional surgery for soft tissue redundancy and no cases of delayed wound healing.
Adequate planning of incisions and soft tissue contouring is important in the care of osseointegrated patients. Plastic surgery involvement can decrease soft tissue complications and lead to improved patient outcomes.
使用传统接受腔假肢的下肢截肢患者面临许多与接受腔 - 肢体界面相关的挑战。骨整合技术的应用使得假肢能够直接附着于骨骼，消除了这一界面并带来了机械优势。与接受腔假肢不同，骨整合假肢需要减少并最小化软组织包膜。研究表明，接受这些植入物的患者因软组织冗余而进行再次手术的比例很高。我们研究的目的是使用我们在植入时围绕假肢进行软组织闭合的技术，评估并发症发生率以及再次手术的必要性。
对2017年6月至2019年6月期间在我们机构接受下肢截肢骨整合假肢植入并同时进行整形手术闭合的所有患者进行了机构审查委员会批准的回顾性病历审查。从电子病历中收集患者人口统计学资料、健康状况描述、手术数据、住院时间和术后并发症发生率，并编码到符合健康保险流通与责任法案（HIPAA）的数据库中。跟踪的具体结果包括轻微和严重感染、骨髓炎、植入物失败、血肿、血清肿、伤口愈合延迟以及再次手术和再次入院率。
在研究期间，共有14例患者接受了骨整合植入物植入，并同时进行了假肢的整形手术覆盖。患者平均年龄为50岁（范围26 - 70岁），平均体重指数为32.2kg/m²（范围19.7 - 44.8kg/m²）。平均随访时间为28周（范围10 - 73周）。有2例局部感染通过口服抗生素疗程得以解决。没有需要进行手术干预或住院治疗的感染病例，也没有骨髓炎病例。2例患者需要门诊手术更换植入物基台，1例因硬件松动需要修复假肢，1例需要对坐骨神经神经瘤进行靶向肌肉再支配。没有患者因软组织冗余需要再次手术，也没有伤口愈合延迟的病例。
在骨整合患者的护理中，充分规划切口和软组织轮廓很重要。整形手术的参与可以减少软组织并发症并改善患者预后。
