Management of Buerger's disease (thromboangiitis obliterans) of the lower limb by horizontal distraction and corticotomy by Ilizarov's technique

Abstract

Introduction: Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a disease of unknown etiology affecting small- and medium-sized blood vessels, mainly seen in heavy smokers. The characteristic features of this disease are distal ischemia, with patients having claudication, rest pain, and toe ulcers. The proper management of TAO is still a challenging problem. Various medical and surgical treatments have been tried with a variable success. Since it is a disease characterized by chronic ischemia, achieving neoangiogenesis could have a beneficial effect. Ilizarov has shown that corticotomy and distraction of bony fragments can increase the blood supply to the entire limb. TAO can be managed using this principle of distraction osteogenesis to induce neoangiogenesis. We conducted this study to evaluate the clinical outcomes of longitudinal tibial corticotomy and horizontal distraction with Ilizarov's fixator in Buerger's disease of the lower limb. Materials and Methods: Ten patients with clinically and radiologically proven Buerger's disease admitted to our hospital between 2019 and 2021 who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy and distraction was performed by the use of olive wires and two-ring frame with horizontal distraction mechanism. Lateral distraction was started after 10 days at the rate of 0.25 mm 6 h for 25 days to achieve a distraction of 2.5 cm. The frame was removed after consolidation of regenerate. Results: Of the 10 cases, eight patients became pain free, while one had a partial relief of pain and one patient worsened on treatment and underwent below-knee amputation. Three patients had at least one episode of pin site infection which improved with oral antibiotics and dressings. One patient had delayed consolidation of regenerate. The claudication distance improved at each follow-up for all but one patient. Conclusion: Neoangiogenesis by corticotomy and distraction offers a relatively simple and cost-effective surgical option to salvage ischemic limbs from amputations and provide pain relief, ischemic ulcer healing, and improved claudication distance, thus improving the quality of life.