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Transverse Kallusdistraktion

Neue Chancen für den Extremitätenerhalt?

Transverse distraction osteogenesis

New chances for limb salvage?

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Zusammenfassung

Die Kallusdistraktion (KD) ist eine Technik, die erfolgreich zur Behandlung von Beinlängendifferenzen und zur Rekonstruktion langstreckiger Knochendefekte angewandt werden kann. Im Zuge einer graduellen Distraktion der Knochenfragmente um ca. 1 mm/Tag kommt es zur Hypervaskularisierung und zum verstärkten Knochenheilungspotenzial (Wachstumsstimulus). Bisher kommt die KD fast ausschließlich longitudinal zur Anwendung, um neues, biologisch aktives Knochengewebe zu generieren. Chronische Wunden, Ulzera und Osteitiden gerade im Fußbereich stellen für den behandelnden Chirurgen immer wieder eine Herausforderung dar, da die Therapieformen langwierig, unsicher im Ausgang und mit möglichem Verlust der Extremität vergesellschaftet sind. Die transverse Kallusdistraktion (tKD) nutzt translational den Wachstumsstimulus der KD zur Behandlung von distal gelegenen, chronischen Wunden und führt dadurch zu einer Beschleunigung der Wundheilung. Am Ende der 5‑wöchigen Behandlung findet sich das weit proximal der chronischen Wunde gelegene, transvers distrahierte, Fragment wieder an seinem ursprünglichen Ort. Der biologische Stimulus wirkt lange nach – länger als die tKD selbst. Weitere Untersuchungen zu den Wirkmechanismen und Behandlungsergebnissen der tKD sind erforderlich. Sollten sich die bisherigen Ergebnisse bestätigen, kann die tKD zum „game changer“ werden und den Extremitätenerhalt bei einem großen Anteil bisher amputationswürdiger Befunde ermöglichen.

Abstract

Distraction osteogenesis (DO) is a technique that can be successfully used to treat leg length discrepancies and to reconstruct long defects of bone. By gradual distraction of the bone fragments by approximately 1 mm per day, hypervascularization and an increased bone healing potential (growth stimulus) occur. So far, DO has almost exclusively been used longitudinally to generate new biologically active bone. Chronic wounds, ulcers and osteitis, especially in the region of the foot, are always a challenge for the treating surgeon, since treatment is tedious, the outcome uncertain and associated with possible loss of the extremity. Transverse distraction osteogenesis (tDO) now uses the growth stimulus of the DO translationally to treat distally located, chronic wounds and thus leads to accelerated wound healing. At the end of the 5‑week treatment, the transversely distracted fragment, located far proximal to the chronic wound, is back in its original location. The biological stimulus has a long-lasting effect, longer than the tDO itself. Further investigations into the mechanisms of action and treatment outcomes of tDO are required. If the previous results are confirmed, tDO may become a game changer and enable the limb salvage for a large proportion of findings that previously required amputation.

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Authors and Affiliations

  1. 3D-Chirurgie, Muskuloskelettales Universitätszentrum München, Klinikum der LMU München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland

    P. H. Thaller MSc & C Ehrnthaller

  2. Sporttraumatologie und Arthroskopische Chirurgie, BG Unfallklinik Murnau, Murnau, Deutschland

    J Fürmetz

  3. Muskuloskelettales Universitätszentrum München, Klinikum der LMU München, Klinikum, Deutschland

    W Böcker

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  1. P. H. Thaller MSc
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  3. W Böcker
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  4. C Ehrnthaller
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Correspondence to P. H. Thaller MSc.

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Interessenkonflikt

P.H. Thaller, J. Fürmetz, W. Böcker und C. Ehrnthaller geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Thaller, P.H., Fürmetz, J., Böcker, W. et al. Transverse Kallusdistraktion. Unfallchirurg 125, 282–287 (2022). https://doi.org/10.1007/s00113-022-01156-1

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  • DOI: https://doi.org/10.1007/s00113-022-01156-1

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