Vascular Management in Rotationplasty

Abstract

The Van Nes rotationplasty is a useful limbpreserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One amputation occurred in the group in which the vessels were preserved. Four patients died secondary to metastatic disease diagnosed preoperatively. The most recent ankle brachial indices were 0.96 and 0.82 for the posterior tibial and dorsalis pedis arteries, respectively, in the reconstructed group. The ankle brachial indices were 0.98 and 0.96 for the posterior tibial and dorsalis pedis arteries, respectively, in the rotated group. Outcomes appear similar using both methods of vascular management and one should not hesitate to perform an en bloc resection when there is a question of vascular involvement. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection

“…The most devastating complication after rotationplasty is vascular compromise of the rotated limb, which can result in eventual above-the-knee amputation or hip disarticulation. Although reported rates of vascular compromise after conventional rotationplasty range from 3.7% to 15.4% [ 1 , 2 , 12 ], the rate only after rotationplasty for revision of infected prosthesis has never been reported. In the conventional method of Van Nes rotationplasty, the femoropopliteal artery and vein are preserved with the sciatic nerve, the neurovascular structures are coiled, and the distal limb is rotated axially 180° and reattached to the proximal stump.…”

“…Regarding the optimal method of vascular management of rotationplasty after the resection of primary sarcomas, no consensus has been reached [ 12 , 13 ]. However, vascular transection and reanastomosis would be the preferred vascular management method for rotationplasty performed for revision of infected prostheses.…”

“…Conventional vascular management during rotationplasty is to preserve major vessels and coil them medially with the distal leg, but recently, the utility of transection and reanastomosis of the major vessels has been widely reported ( Figure 1 ) [ 1 , 2 , 12 – 14 ]. However, no consensus has been reached regarding the optimal method of vascular management of rotationplasty after the resection of sarcomas [ 1 , 12 , 13 ]. Furthermore, there has been little discussion regarding the vascular management of rotationplasty for revision of infected prosthetic knee joints [ 1 ].…”

Rotationplasty for Unplanned Fixation of Pathological Fracture Distal Femoral Osteosarcoma

“…In this patient, rotationplasty type A was performed while preserving major neurovascular bundles. However, if the margin of control became vulnerable with contamination of the vessels, a vascular bypass surgery may be necessary, and vascular anastomosis did not increase the risk of rotationplasty failure [13]. Many incision and surgical techniques had been reported to facilitate the ease of the operation while minimizing the complications [10].…”

Whatʼs New in Musculoskeletal Oncology

“…It is not clear whether one method results in superior outcomes and a lower complication rate. Mahoney et al 44 examined the ankle brachial indices and complication rates in two groups of patients managed with each technique and concluded that both vascular management options are safe and that the complication rates are equal.…”