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Vascular Management in Rotationplasty

Abstract

The Van Nes rotationplasty is a useful limb-preserving 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.

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Acknowledgments

We thank Dr. Craig Walker for assistance in interpretation of the MRIs, Kerby Selmer for assistance with the patient database, and Dr. Kaleb Michaud for assistance with the statistical analysis.

Author information

Correspondence to Craig R. Mahoney MD.

Additional information

James R. Neff—Deceased.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

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Mahoney, C.R., Hartman, C.W., Simon, P.J. et al. Vascular Management in Rotationplasty. Clin Orthop Relat Res 466, 1210–1216 (2008) doi:10.1007/s11999-008-0197-4

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Keywords

  • Sciatic Nerve
  • Synovial Sarcoma
  • Ankle Brachial Index
  • Vascular Resection
  • Orthopaedic Oncologist