Journal of Orthopaedic Translation (Nov 2020)
Balloon Dilatation Technique for prevention and treatment of soft-tissue invagination in bone transport
Abstract
Summary: Introduction: Soft-tissue invagination is a common complication during the process of bone transport but lacks the effective methods for the treatment and prevention. The aim of this study is to analysis the effectiveness of a new type of method, Balloon Dilatation Technique (BDT), for the treatment and prevention of soft-tissue invagination. Materials and methods: We retrospectively analyzed the clinical data of 17 patients (17 limbs), who underwent the BDT between July 2010 and February 2019. The BDT was used as a prevention role for 11 patients and for 6 patients as a treatment role. For all our patients, a balloon dilatator was surgically implanted in the bone gap. By injection of normal saline, the dilatator was immediately expanded during the surgery in the prevention group or was gradually expanded after surgery in the treatment group. When the saline-filled dilatator was squeezed by the bone ends, the injected saline was evacuated. The removal of the balloon dilatator was performed when the empty balloon impeded bone transport. Patient characteristics, perioperative complications, additional surgical procedures, rate of distraction, and clinical outcomes in the both of groups were recorded. Results: The operation of dilatator implantation was performed alone without other procedures in 2 of the 6 patients in treatment group. Docking site revision was conducted at the time of dilatator removal in all patients. Soft-tissue invagination did not occur in prevention group and was successfully treated in treatment group. No major complications, such as dilatator breakage, neurovascular compromise, deep infection, flap necrosis, or invagination recurrence, were noted in the both of groups. Conclusion: The BDT could be considered to prevent or treat soft-tissue invagination during the process of bone transport. The Translational potential of this article: This study provides an effective method (BDT) to dynamically prevent or treat soft-tissue invagination during the process of bone transport. Proper patient selection and correct management of the dilatator are essential when applying this technique. Our clinical experience may contribute to better management of Ilizarov bone transport.
