Principles of Rotationplasty

Gupta, Sumit; Alassaf, Nabil; Harrop, Robertson; Kiefer, Gerhard

doi:10.5435/00124635-201210000-00005

Cited by 32 publications

(28 citation statements)

References 47 publications

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“…The femur showed a highly mobile recalcitrant pseudarthrosis at the supracondylar level, while the knee was stiff and fixed in extension. The ankle was also rigid and held in plantar flexion and thus, a Van Ness rotationplasty procedure was disregarded . An ischial weight‐bearing prosthesis was necessary to walk.…”

Section: Casementioning

confidence: 99%

Vascularized tibial periosteal graft in complex cases of bone nonunion in children

et al. 2014

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Bone nonunion in the pediatric population usually occurs in the context of highly unfavorable biological conditions. Recently, the vascularized fibular periosteal flap has been reported as a very effective procedure for treating this condition. Even though a vascularized tibial periosteal graft (VTPG) was described long ago and has been successfully employed in one adult case, there has been no other report published on the use of this technique. We report on the use of VTPG, pedicled in the anterior tibial vessels, for the treatment of two complex pediatric bone nonunion case: a recalcitrant supracondylar femoral pseudarthrosis secondary to an infection in an 11-year-old girl, and a tibial nonunion secondary to a failed bone defect reconstruction in a 12-year-old girl. Rapid healing was obtained in both cases. In the light of the data presented, we consider VTPG as a valuable surgical option for the treatment of complex bone nonunions in children.

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Section: Casementioning

confidence: 99%

Vascularized tibial periosteal graft in complex cases of bone nonunion in children

et al. 2014

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“…Rotationplasty permits wide resection, offering oncologic outcomes comparable to amputation but preserving a useful limb. Despite possible disadvantages as the cosmetic appearance of the rotated limb, difficulties in mental acceptance and possible need of subsequent bone lengthening and rotational osteotomies (as the limb might alter its rotatory alignment during growth), patients have high satisfaction rates, function, and quality of life (Gradl et al, ; Gupta et al, ). Because of active control of the neo knee joint, the walking speed, gait, oxygen consumption, and general functional scores are significantly better in rotationplasty patients compared with above‐knee amputees.…”

Section: Discussionmentioning

confidence: 99%

“…Because of active control of the neo knee joint, the walking speed, gait, oxygen consumption, and general functional scores are significantly better in rotationplasty patients compared with above‐knee amputees. In pediatric patients this procedure is associated with better outcomes compared with endoprosthesic replacement (Badhwar & Agarwal, ; Gradl et al, ; Gupta et al, ; Hillmann, Hoffmann, Gosheger, Krakau, & Winkelmann, ).…”

Section: Discussionmentioning

confidence: 99%

“…Rotationplasty is an alternative to above‐knee amputation or hip disarticulation in lower extremity deficiencies (Kotz, ). In malignancies of either the distal femur or the proximal tibia, after intercalary resection of the knee, the distal limb is rotated 180º in the longitudinal axis, and repositioned to allow ankle to function as a knee, which can be fitted with a custom‐made below‐knee prosthesis (Borggreve, ; Gupta, Alassaf, Harrop, & Kiefer, ; Van Nes, ). Good oncological, functional, and psychosocial outcomes have been documented with this procedure (Gradl et al, ; Steenhoff, Daanen, & Taminiau, ).…”

Section: Introductionmentioning

confidence: 99%

“…Encasement of the sciatic or tibial nerve, requiring its resection, has been considered a major contraindication for this technique (Fuchs & Sim, ; Gupta et al, ). In contrast, vascular infiltration by the tumor does not preclude rotationplasty, as vessels may be resected and re‐anastomosed (Tiwari, Agrawal, & Kocak, ).…”

Section: Introductionmentioning

confidence: 99%

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Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18‐month‐old patient

Pérez‐García¹,

Taverner²,

Villaverde-Doménech³

et al. 2017

Microsurgery

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Rotationplasty is a limb-sparing surgical option in lower limb malignancies. Sciatic or tibial nerve encasement has been considered an absolute contraindication to this procedure. We report a case of an 18-month-old girl with a rhabdomyosarcoma that affected the leg and popliteal fossa, with neurovascular involvement. Knee and proximal leg intercalary resection was performed followed by reconstruction with free microvascular rotationplasty and neurorraphy from tibial division of sciatic nerve to sural and tibial nerves, and from saphenous nerve to superficial peroneal nerve. Postoperative course was uneventful and ambulation with a provisional prosthesis was restarted during the sixth week after surgery. Bone consolidation was observed after two months. Eighteen months later, the patient had a good gait pattern with a below-knee prosthesis and had recovered sensation in the whole foot and ankle area. This case shows that rotationplasty with nerve repair may provide a sensate stump, which is vital for successful prosthetic adaptation. We believe it may be considered as an alternative to above-knee amputation in tumors with sciatic involvement.

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