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

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Osseointegration provides a direct prosthesis interface for lower-limb amputees, many of whom are poor candidates for traditional socket-suspended prostheses. These skeletally anchored implants eliminate the skin-prosthesis interface, reducing complications such as soft-tissue breakdown, ulceration, and pain 1 . Soft-tissue contouring and management of peripheral nerves are essential aspects of osseointegrated implantation surgery for both transfemoral and transtibial amputees. These techniques protect the bone-implant interface, prevent skin-implant friction, and reduce neuroma formation, thus mitigating complications and maximizing patient satisfaction 2,3 . Description In the present video article, we describe a technique for soft-tissue contouring during single-stage limb osseointegration that involves mobilizing the anterior and posterior musculature to cover the bone-implant interface without excess 4 . Peripheral nerves (i.e., the sciatic and femoral nerves for transfemoral osseointegration and the common peroneal, sural, and posterior tibial nerves for transtibial osseointegration) are identified, and targeted muscle reinnervation (TMR) is performed on each nerve. A regenerative peripheral nerve interface (RPNI) may also be utilized if there is a large size discrepancy during nerve coaptation. We excise redundant soft tissue, performing medial thigh lifts as

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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