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Vascular management in rotationplasty.

Craig R Mahoney¹, Curtis W Hartman, Pamela J Simon

¹The Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA. iowamahoneymd@aol.com

Clinical Orthopaedics and Related Research

|March 19, 2008

Summary

This summary is machine-generated.

The Van Nes rotationplasty offers limb preservation for pediatric bone cancers. Both vascular preservation and transection yield similar outcomes, supporting en bloc resection for suspected vascular involvement.

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Area of Science:

Orthopedic Oncology
Pediatric Surgery
Vascular Surgery

Background:

The Van Nes rotationplasty is a critical limb-sparing surgery for pediatric patients with distal femur or proximal tibia malignancies.
Management of vascular supply during this procedure involves either preservation and rotation or transection and reanastomosis.

Purpose of the Study:

To compare the ankle-brachial index (ABI) and complication rates between two vascular management techniques in Van Nes rotationplasty.
To evaluate the safety and efficacy of en bloc resection when vascular involvement is suspected.

Main Methods:

Retrospective review of 16 skeletally immature patients undergoing Van Nes rotationplasty.
Vascular management categorized into: vessel preservation/rotation (9 patients) versus vessel transection/reanastomosis (7 patients).
Comparison of postoperative ABI and complication rates between the two groups.

Main Results:

One amputation occurred in the vessel preservation group; no amputations in the transection group.
Postoperative ABIs were comparable between groups (Posterior Tibial: 0.96 vs. 0.98; Dorsalis Pedis: 0.82 vs. 0.96).
Four patients died due to preoperative metastatic disease, unrelated to surgical vascular management.

Conclusions:

Both vascular preservation/rotation and transection/reanastomosis appear to yield similar functional outcomes and complication profiles in Van Nes rotationplasty.
En bloc resection is a viable option even with suspected vascular involvement, without compromising limb viability.
The choice of vascular management should not deter oncologic resection in challenging cases.