TAO

TAO / BURGER'S DISEASE

A 25 years old male, heavy smoker and tobacco chewer presented with TAO of left lower limb with non healing ulcer over medial aspect of foot with amputated great, second and third toes. Initially he was treated by general surgeon for lumbar sympethectomy without any improvement. After that vascular surgeon did by pass surgery by putting left radial arterial graft without any improvement. Ultimately patient came to us with rest pain, non healing ulcer with shaggy necrotic tissue.

FIG 1

On arteriogram lower femoral and upper popliteal filling was present with absent dorsalis pedis and posterior tibial.

FIG 2

After failure of conventional methods we took this patient for lateral distraction of spitted tibia for neo histogenesis.

SURGERY
1. Frame fixation done for lateral distraction of spitted tibia.(FIG 3)
2. Distraction at a rate of .25 mm / 6 hourly means 1 mm per day was continued for 20 days. So wound became cherry red with healthy granulation tissue and development of micro circulation.
3. Split thickness grafting done over raw area.
4. Wound healed completely with total disappearance of rest pain.
5. Patient able to walk with shoes for 2 kilometers.

FIG 3

FIG 4

FIG 5

FIG 6

PLEASE REFER FOLLOWING ARTICLE OF MINE TO GET MORE DETAILS OF MANAGEMENT OF TAO BY DISTRACTION OSTEOGENSIS.
Patwa JJ, Krishnan A. Buerger's Disease (Thomboangitis Obliterans): Management by Illizarov's technique of horizontal distraction: A retrospective study of 60 cases.
Indian J Surg 2011;73:40-7