Tibial cortex transverse distraction for primarily lymphoedema in the lower limb: A case report

Abstract

Summary: Lymphoedema is a debilitating condition, manifesting in excess lymphatic fluid and swelling of subcutaneous tissues. It is as of yet still an incurable condition and current treatment modalities are not satisfactory. In this report, a new surgical technique---tibial cortex transverse distraction (TCTD) is tried for the treatment of this disease. A 59-year-old women with primary lymphoedema had obvious edema and aching of her right lower limb for six months. The patient received the surgery of TCTD: a corticotomy window (length∗width, 5 cm∗1.5 cm) was opened on her right medial upper tibia. With an external fixator, the bone window was given a daily distraction for two weeks. The aching of the right lower limb was lessened in the second day postoperatively and disappeared on the 10th day after the surgery. The edema of limb decreased slowly but steadily at the following six months.The discussion includes the possible mechanisms of TCDT and its usage in the treatment of other diseases. This surgery could play a role for lymphedema treatment and merits further studies. The translational potential of this article: ”The surgery of tibial cortex transverse distraction has the potential to improve the symptoms of limbs lymphoedema.”

Keywords

• Distraction
• Ilizarov techniques
• Lower limbs
• Lymphoedema
• Tibia