<< Back to the abstract archive
The use of free microvascular techniques to improve the results of the traditional Van Nes rotationplasty
Sumita Saha MD, Melissa Kinder MD, Pankaj Tiwari MD, Joel Mayerson MD
The Ohio State University Medical Center, Columbus, Ohio
2010-03-26
Presenter: Sumita Saha, MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
The Van Nes rotationplasty is a successful limb-salvage method for reconstructing the pediatric patient after resection of distal femoral or proximal tibial osteosarcoma. After resection of the tumor, the distal leg is rotated and preserved to augment limb length. With an appropriate prosthesis, the ankle joint serves the function of the removed knee joint. As described in the orthopedic literature, the Van Nes rotationplasty is traditionally performed as a pedicled rotation flap, with tedious dissection and preservation of all vessels and nerves around the tumor. In the first case of our series, coiling of the redundant vessels to the distal leg resulted in thrombosis and flap loss, resulting in amputation. In the two following cases, the intervening vasculature was removed along with the tumor and the distal pedicles were anastomosed to their proximal counterparts using free microvascular technique. Only the sciatic nerve was preserved in continuity with its branches throughout the resection. In addition to expediting resection of the tumor as well as allowing wider tumor resection margins (especially in cases where tumor invades the vasculature), this technique eliminates the redundancy of the vessels and precludes thrombosis and subsequent flap loss.
