Ultrasonic bone scalpel for long bone resections in limb reconstruction: Device description and case series

While the ultrasonic bone scalpel (UBS) has shown benefits, including decreased surgical duration, blood loss, and local tissue thermal injury, its implementation has been limited to skull base and spinal surgery. This case series sought to determine the safety and advantages of the UBS for bony resections in limb reconstructive procedures. A retrospective review of four patients with a median age of 42 ± 13.38 at the time of resection and bone segment transport (BST) surgery was performed with UBS. Patients with prior history of lower extremity trauma with sequelae including non-union (2), osteomyelitis (1), or both (1). Intraoperative and post-operative courses and complications were documented. Each patient underwent tibial resection with UBS with a median bone resection size of 6.6 ± 2.85. Three patients underwent BST using cables and external fixator and one underwent plate-assisted BST with an intramedullary device. All patients had proximal corticotomies and antegrade transport, with a formal docking procedure at the end of transport. Complications included fixator cable tensioning device failure, frame readjustment, and pin tract infections. Two patients required subsequent grafting for docking site nonunion. One patient terminated bone transport early. No neurovascular injuries, hematomas, or dead space infections were reported. The UBS offers a safe mechanism for long bone resections in lower extremity limb reconstruction. Neurovascular structures within the resection zone were preserved and uninjured, demonstrating major advantages in using this technology. Further study is needed to assess the risk for docking site nonunion with UBS.