Osseointegration – Procedure
Major limb osseointegration, is usually performed as a 1-stage operation. Historically, a 2-stage procedure was performed with a gap of 4 to 6 weeks between stages. However, experience has confirmed that a single-stage procedure results in faster patient rehabilitation and minimises the risks (especially infection) associated with multiple procedures.
However, depending on the individual patient, multiple, staged procedures may still be required. This is particularly true when performing osseointegration surgery in the head and neck region or in the hand.
Surgery is usually performed under general anaesthesia. This will be augmented with a spinal or epidural block (for lower limb patients) or brachial plexus nerve block (for upper limb patients). In some cases, surgery may be performed under spinal or brachial plexus block alone, together with intravenous sedation.
An incision is made at the distal end of your stump. The wound is then opened in layers to expose the end of your residual bone. Using special instruments, the end of the bone is prepared by removing any unwanted spurs or areas of heterotopic ossification (heterotopic ossification is the term given to the presence of bone in the soft tissues where bone does not normally exist). Your surgeon will then explore and deal with any neuromas.
Your muscles are re-organised and grouped in a circumferential manner by attaching them directly to the bone. This will allow you to have better control over the residual limb in the future and also helps to maintain the shape of the soft-tissue/implant interface.
The bone canal is prepared by sequential reaming using special instruments that convert the bone canal from an oval to a cylindrical shape. Broaches are then utilised to match the shape and create the final shape of the bone for your implant. Any bone that is removed during this process is carefully saved for use as a bone-graft – if necessary. Once the implant cavity is ready the implant is carefully press-fitted into the prepared bone. If needed, the bone-graft can now be inserted to augment the fit.
A soft tissue flap is prepared by removing excess subcutaneous tissue fat. This skin flap is then used to cover the muscles and the implant and is secured in place using surgical staples. A circular opening (stoma) is created in the skin flap through which the tip of the implant can project through the skin. The transcutaneous components of the implant are carefully attached to the implant through this opening. Following this, a wound dressing is applied.
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