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Expansion Procedure

Patient positioning

Place the patient in a lateral decubitus or prone position.

Exposure

Identify the approximate location of the caudal Closure for
Extension Bar through palpation and/or radiographic marker.
Make a transverse or longitudinal incision over the closure.

Remove the lock

Required instruments

388.452

Lock Removal Pliers, for VEPTR

388.462

Lock Removal Device, for VEPTR

Remove the golden Closure for Extension Bar using the Lock
Removal Pliers or the Lock Removal Device.

Synthes

VEPTR

Technique Guide

Summary of Contents for VEPTR

Page 1: ...VEPTR Vertical Expandable Prosthetic Titanium Rib A new treatment concept for paediatric three dimensional thoracic deformities Technique Guide...

Page 2: ......

Page 3: ...uments are required For further details contact your local Synthes representative Table of Contents Image intensi er control Treatment Concept 3 Indications 4 Contraindications 5 Construct Options 6 I...

Page 4: ...2 Synthes VEPTR Technique Guide...

Page 5: ...ts VEPTR devices control and may correct scoliosis Devices are attached perpendicularly to the patient s natural ribs superior at tachment point and to more caudal ribs a lumbar vertebra or to the ili...

Page 6: ...due to absent ribs Progressive thoracic congenital neurogenic or idiopathic scoliosis without rib abnormality Hypoplastic thorax syndromes Jeune s Syndrome Jarcho Levine Syndrome Cerebro costal mandib...

Page 7: ...Age below 6 months Known allergy to any of the device materials Infection at the operative site Warnings and precautions Patients implanted with the VEPTR should not be braced The VEPTR device is des...

Page 8: ...VEPTR Technique Guide Construct Options The VEPTR set contains 220 mm and 70 mm radius constructs 220 mm radius constructs are used to treat most of the VEPTR indications and are the standard VEPTR c...

Page 9: ...riosteum to enable anterior and posterior osteotomies Perform anterior and posterior osteotomies from ribs three through eight Distract the mobilized chest segment postero laterally Place retractors s...

Page 10: ...Ring 3 Lock for Rib Support 4 Lumbar Extension Rod 5 Extension Bar 6 Closure for Extension Bar 7 Lamina Hook Rib to ilium Attaches from rib to ilium Components available in 220 mm radius 1 Cranial Rib...

Page 11: ...mm radius Rib to rib 220 mm radius 1 Cranial Rib Support 2 Closing Half Ring 3 Lock for Rib Support 4 Caudal Rib Support 5 Extension Bar 6 Closure for Extension Bar Rib to rib 70 mm radius 1 Cranial...

Page 12: ...220 mm radius available in sizes 4 13 in neutral right and left angulation Art No Angulation Sizes 497 065 497 069 Neutral 4 8 497 225 497 229 Neutral 9 13 497 071 497 075 Right angled 4 8 497 230 497...

Page 13: ...ed Art No 497 129 Closing Half Ring for Rib Support large Locks Titanium Alloy TAN Lock for Rib Support blue connects the Closing Half Ring to the Cranial Rib Support or the Caudal Rib Support Art No...

Page 14: ...sizes 4 13 Art No Sizes 497 103 497 112 4 13 In 70 mm radius available in sizes 4 11 Art No Sizes 497 115 497 122 4 11 Lumbar Extension Rod Titanium Alloy TAN Attaches the Extension Bar to the Lamina...

Page 15: ...crew secures the placement Art No Angulation 497 261 Left angled 497 262 Right angled Ala Hook Pure Titanium Used with the Lumbar Extension Rod and Extension Connector to attach to the ilium Available...

Page 16: ...nector 5 0 6 0 Titanium Alloy TAN Connects the Ala Hook to the Lumbar Extension Rod Accepts 5 0 mm and 6 0 mm rods Art No 498 167 Extension Connector 5 0 6 0mm Rod 2 0mm Pure Titanium Holds osteotomiz...

Page 17: ...d 497 128 from the constructs for expan sion procedures or removing constructs 388 453 or Holding Forceps for Closing Half Ring for 388 465 VEPTR For holding and placing the Closing Half Ring around t...

Page 18: ...rt Goes around the Extension Bar and is used with the Iron for Rib Support 388 461 Holding Forceps for Rib Support Holds the Cranial and the Caudal Rib Supports 388 462 Lock Removal Device for VEPTR U...

Page 19: ...s the same shape as the rib support devices 388 468 Holding Forceps for Extension Bar For holding the Extension Bar and pushing it over the Cranial Rib Support and Caudal Rib Support 388 471 Rib Distr...

Page 20: ...88 486 Foot for Rib Retractor for No U22 64010 Fits in the Rib Retractor to distract the ribs 388 493 Inserter for Rib Support Lock Used to pick up and hold the locks 497 125 and 497 128 and attach th...

Page 21: ...construct Ala Hook for rib to ilium constructs 6 1 Select the appropriate lumbar extension 6 2 Determine contour and cut to length if necessary 6 3 Insert caudal Distraction Lock 6 4 Insert caudal im...

Page 22: ...ubitus position similar to that required for a standard thoracotomy To protect against brachial plexus injury do not flex the shoulder more than 90 2 Cranial exposure Make a J shaped thoracotomy incis...

Page 23: ...eral 388 488 Clip for Rib Support for No 388 494 388 489 Clip for Closing Half Ring for No 388 494 388 493 Inserter for Rib Support Lock 388 494 Pliers for Closing Half Ring and Rib Support 398 408 Pe...

Page 24: ...teum adjacent to the lung Take care to preserve the soft tissue surrounding the rib to protect rib vascularity and the neurovascular bundle 3 3 Select proper Cranial Rib Support Choose a 220 mm or 70...

Page 25: ...teum and the rib Rotate the rib support into the correct position For the medial construct seat as medial as possible to the transverse process 3 5 Select proper Closing Half Ring size Based on the pa...

Page 26: ...Rib Support The Closing Half Ring and Cranial Rib Support now should be aligned Note If the Cranial Rib Support and Closing Half Ring are not aligned prepare the Pliers for Closing Half Ring and Rib S...

Page 27: ...nsert the lock into the aligned holes of the Cranial Rib Sup port and the Closing Half Ring With a hammer gently tap inserter to seat the lock The Lock Crimper or the lateral Lock Inserter should be u...

Page 28: ...8 mm length 210 mm 399 130 Bone Spreader speed lock width 12 mm length 270 mm Assemble the Feet for Rib Retractor to the Retractor Distract ribs using the Rib Retractor assembly as needed Bone Spread...

Page 29: ...ilium or rib to lumbar lamina construct Measure to the caudal rib when using a rib to rib con struct The measurement in centimeters will correspond to the cor rect Extension Bar size For example if th...

Page 30: ...r Rib Support 388 459 Iron for Extension Bar 388 461 Holding Forceps for Rib Support 388 466 Positioner for Rib Support 388 468 Holding Forceps for Extension Bar 388 475 Lock Inserter lateral 388 493...

Page 31: ...er The length of the rod portion of the lumbar extension should be at least equal to the distance between the thoracolumbar junction and the planned caudal implant When using a Lamina Hook or Ala Hook...

Page 32: ...from the underside of the lamina to ensure good bony contact with the Lamina Hook and to leave the inter spinous ligament intact Resect enough ligamentum flavum for the hook to pass Choose the approp...

Page 33: ...est The tip of the periosteal elevator should be just lateral to the Sacro iliac joint Choose the appropriate Ala Hook 45 or 90 left or right The correct Ala Hook should have the upper end lying media...

Page 34: ...ion Take care to remain within the paraspinous muscles Use Rod Holding Forceps to insert the rod portion of the lumbar extension assembly to reach the hook Ala Hook Use for rib to ilium construct Thre...

Page 35: ...and Holding For ceps for Rib Support to slide the cranial end of the Extension Bar over the Cranial Rib Support Alternatively the Iron for Extension Bar and the Iron for Rib Support can be used to ali...

Page 36: ...g the Lock Crimper or lateral Lock Inserter A 6 8 If using a lamina hook distract if necessary and tighten Using the 2 5 mm Hex Screwdriver place a Fixation Ring for Rod cranial to the hook onto the r...

Page 37: ...461 Holding Forceps for Rib Support 388 464 Spreader for Rib Support 388 466 Positioner for Rib Support 388 468 Holding Forceps for Extension Bar 388 471 Rib Distraction Pliers 388 472 Distractor for...

Page 38: ...ound the rib Based on the patient s anatomy select the appropriate Clos ing Half Ring standard or large Using the Holding Forceps for Closing Half Ring seat the Closing Half Ring over the contralatera...

Page 39: ...he Closure is fully seated Use the Rib Distraction Pliers Distractor for Extension Bar or the Spreader for Rib Support to distract the device until the caudal hole in the Extension Bar is aligned with...

Page 40: ...r Extension Bar through palpation and or radiographic marker Make a transverse or longitudinal incision over the closure 3 Remove the lock Required instruments 388 452 Lock Removal Pliers for VEPTR 38...

Page 41: ...until the device is adequately lengthened Use the Temporary Distraction Pins as placehold ers to assist distraction 5 Final locking Required instruments Standard Hammer 388 456 or Lock Crimper for VEP...

Page 42: ...of the previous thora cotomy incision may be used Unlock the device by removing the golden Closure s for Ex tension Bars using the Lock Removal Pliers Remove the required components and insert the ne...

Page 43: ......

Page 44: ...0123 036 000 421 SM_706950 AB 51060016 Synthes 2007 Subject to modifications Presented by 036 000 421 ABh...

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