Saucerization of Distal Tibia: Surgical Technique
Saucerization is a surgical technique involving subperiosteal excision of new bone with attached cyst contents and curettage of remaining cortical bone, creating a saucer-shaped cavity that heals centripetally from periphery to center. 1
Core Surgical Steps
The technique consists of the following sequential components:
1. Subperiosteal Excision
- Remove the subperiosteal new bone layer along with its attached cyst contents 1
- This creates exposure to the underlying cortical bone while preserving the periosteal envelope
2. Cortical Curettage
- Thoroughly curette the remaining cortical bone to remove all pathological tissue 1
- The goal is to create a clean, saucer-shaped cavity with healthy bone margins
3. Periosteal Closure
- Close the periosteum over the created cavity 1
- This preserved periosteal layer is critical for the healing process
4. Bone Marrow Augmentation (Optional Enhancement)
- Consider instillation of autologous bone marrow into the cavity to augment healing 1
- This avoids morbidity and costs associated with traditional bone grafting 1
- Bone marrow injection provides osteogenic cells without requiring separate graft harvest sites
Healing Pattern
The cavity heals via centripetal ossification, where new bone formation advances from the periphery toward the center 1. This pattern is characteristic of saucerization and distinguishes it from other bone healing techniques.
Alternative Approach for Chronic Osteomyelitis
When saucerization is used for chronic osteomyelitis of the distal tibia:
- Perform open excision and grafting after saucerization 2
- Secondary closure or skin grafting may be required 2
- This approach has demonstrated effectiveness even in cases referred for amputation 2
Key Technical Considerations
- The technique is particularly effective for aneurysmal bone cysts and chronic osteomyelitis of long bones 1, 2
- Preservation of the periosteum is essential for successful centripetal healing 1
- The saucer-shaped cavity must have adequate depth to remove all pathological tissue while maintaining structural integrity