Peroné pro-tibia modificado: transferencia de peroné vascularizado ipsilateral por técnica percutánea. a propósito de un caso / Modified fibula-pro-tibia: ipsilateral vascularized fibular transfer by percutaneous technique. A purpose of a case

RESUMEN

Ante defectos masivos a nivel de la tibia, se consideran técnicas que comprometan mínimamente las partes blandas y garanticen la viabilidad, funcionalidad de la extremidad y sea accesible para la población. Por primera vez en la literatura, a propósito de un caso, se describe la técnica de Huntington y se modifica de manera netamente percutánea, tomando como criterio de selección una extremidad severamente lesionada, con gran defecto diafisiario, para lo cual se realizó centralización del peroné de manera percutánea y fijación externa con alambres de Kirschner y retiro de material a los 5 meses. Actualmente, presenta discrepancia de miembros inferiores de 5cms, y marcha independiente soportada con suela compensatoria. Esta técnica puede ser empleada en niños y adolescentes; no se recomienda en caso de zonas metafiso-epifisiarias. Se basa en el menor compromiso de partes blandas, menor desperiostización y posibilidad de lesiones vasculonerviosas; ofrece una solución viable ante grandes defectos tibiales a ser considerado por el cirujano ortopedista(AU)

ABSTRACT

Several techniques have been considered to improve major tibia defects, all of them have been in minimally invasive surgery with less injury on the soft tissue, ensuring function and viability of the extremity, as well as and easy treatment access by patients. This is first time in literature Huntington's technique is described and modified purely to the percutaneous level, with an evidence degree type IV. In this particular case we took into consideration the selection of a severely-injured extremity with a large diaphysis defect, which experienced centralization of the fibula to Huntington's technique, was rearranged at the percutaneous level, and externally fixated temporally with Kirschner needle. Lower discrepancy less than 5 centimeters between both extremities is showed as final results; supported independent walking with compensatory sole. This technique can be used in children and adolescents; however it is not recommended in cases where metaphyseal- epiphyseal zones are affected. Aiming to goal for the least damage and compromise of the soft tissue, as well as periosteomy, and possibilities of vascular or nervous lesions, this technique offers a viable solution against major tibia defects and could be considered by the orthopedic surgeon(AU)