Use of a "Fascial-Sock" Technique to Manage the Stump and Stoma After Insertion of an Osseointegrated Implant in Transfemoral Amputees.

Introduction: We describe a new surgical technique to improve the stability of the peristomal skin around an osseointegrated implant in transfemoral amputees. As a secondary effect, the technique makes it easier to shape the residual limb into a cone and reduces the need for more complex revision surgery in the years after surgery.

Methods: We compared outcomes in 2 groups of unilateral, transfemoral amputees by 18 months after insertion of an osseointegrated prosthetic limb implant. In Group 1, the soft tissues were managed using a standard muscle-platform technique. In Group 2, the soft tissues were managed using a fascial-sock technique. Rates of peristomal infection requiring treatment with oral antibiotics, rates of peristomal enthesopathy pain, surgical revision rates, and effectiveness of peristomal skin adhesion to the underlying bone were assessed.

Results: Rates of peristomal skin infection were 50% lower in Group 2. Rates of treatment for enthesopathy pain were 50% lower in Group 2. Surgical revision rates were the same in both groups. However, the need to revise the stoma specifically was 50% lower in Group 2 and the nature of the revision procedures in Group 2 were less complicated (mainly for soft-tissue overhangs). By contrast, the need for bony debridement as part of the revision procedure was 4 X greater in Group 1 compared with Group 2. Finally, we were 1.8 X more likely to achieve a dry and stable stoma by 18 months using a fascial sock approach.

Conclusion: Use of a fascial sock approach appears to be associated with improved rates of stability of the peristomal soft tissues, leading to decreased morbidity from this area at 18 months after treatment with an OI implant.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.