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Indian J Orthop. 2011 Sep;45(5):459-64. doi: 10.4103/0019-5413.83954.

Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study.

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  • 1Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India.

Abstract

BACKGROUND:

Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20-50 years were treated with the Ilizarov method.

MATERIALS AND METHODS:

Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases.

RESULTS:

Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5-2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4-6 weeks.

CONCLUSION:

The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.

KEYWORDS:

Distraction osteogenesis; Ilizarov ring fixator; thromboangiitis obliterans

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