Successful combined use of the Ilizarov technique and Taylor spatial frame spared a healthy mother of two from the amputation of her left leg (above the knee) following a traumatic accident; the team was able to save her knee and work to heal it before any amputation needed to occur. According to J. Spence Reid, M.D., trauma surgeon, Penn State Hershey Bone and Joint Institute, “An initial attempt to reconstruct the knee failed when massive infection developed. Debridement of infected tissue and bone resulted in large bone defects.” Reid and the patient discussed amputation versus preserving the limb. “As an active young woman, the patient and her family felt very strongly about trying to preserve the leg.” Thankfully there were options.
After enduring six months of the Ilizarov and Taylor spatial frame techniques, and eight surgeries in 12 months, including fusion of the knee and placement of an intermedullary nail, the bone defects have fully healed and the patient is able to walk and perform most normal daily activities with no pain or ambulatory aids. Reid adds, “This was a highly personal decision to undergo an arduous, painful, and expensive series of treatments. While this approach is not for everyone, the patient and her family are very satisfied with the outcome.” Continue reading
Severe lower extremity trauma often results in the loss of bone, muscle, and skin. Reconstruction of these injuries is extremely challenging due to the amount of bone that must be reconstructed and the size of wounds that must be closed. Wound coverage is usually achieved with the use of a microvascular free flap procedure performed by plastic surgeons. In this technique, healthy tissue is brought to the damaged region and attached to the local blood vessels to allow it to live and grow. Restoration of the lost bone can be accomplished with repeated massive bone grafting, but this is often unreliable.
J. Spence Reid, M.D., Penn State Hershey Bone and Joint Institute explains, “The Ilizarov technique, coupled with the recently developed Taylor spatial frame offers an alternative approach, that while labor intensive, is very reliable and precise in restoring missing bone.” This technique was pioneered by the Soviet orthopaedic surgeon, Gavriil Abramovich Ilizarov and employs a circular external fixation frame (figure A) with percutaneous wires and pins attached to metal rings to move bone segments from the outside of the skin. The Taylor spatial frame is a refinement of the original frame and differs from the original in that the rings are connected by six angled struts that are adjusted by the patient. The daily position of each strut is determined by the use of a computer program providing accuracy down to one millimeter.