Modified Borggreve-Van Nes-Winkelmann rotationplasty for surgery in developing countries

Area of Science:

• Orthopaedic Surgery
• Surgical Oncology
• Limb Reconstruction

Background:

• Amputation remains the primary treatment for osteosarcoma in Myanmar, despite limb salvage surgery being the current standard.
• Complex procedures like rotationplasty require safe and reliable techniques, especially in lower-middle income economies with limited resources.

Purpose of the Study:

• To present seven cases of Borggreve-Van Nes-Winkelmann rotationplasty for osteosarcoma in Myanmar.
• To evaluate the safety and sustainability of a modified rotationplasty technique in a resource-limited setting.

Main Methods:

• Seven young patients with distal femur or proximal tibia osteosarcomas underwent modified Borggreve-Van Nes-Winkelmann rotationplasty.
• Modifications included dissection and clamping of the femoral artery to minimize blood loss and creating an adipocutaneous flap to reduce swelling and pressure on vessels.

Main Results:

• All seven patients achieved good functional and aesthetic outcomes.
• One patient required secondary wound closure due to wound dehiscence.

Conclusions:

• A simplified and safe Borggreve-Van Nes-Winkelmann rotationplasty technique was successfully adapted for lower-middle income economies.
• The modified procedure proved feasible and effective under challenging resource constraints.