<< Back to the abstract archive
Technical Pearls to Maximize Outcomes in Rotationplasty
Steven A. Schulz, MD
Michael Larsen, MD
Ian A. Valerio, MD
The Ohio State University
2018-02-15
Presenter: Steven Schulz
Affidavit:
I, Albert Chao, verify that Steven A. Schulz was responsible for the 100%data acquisition for this project, assisted with the study design 50%, 50% of data interpretation and 75% of the abstract preparation.
Director Name: Albert Chao
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Rotationplasty involves limb shortening and a 180 degree rotation of the distal lower extremity thus transforming the ankle joint into a viable knee joint for length preservation and prosthetic wear. This procedure provides an autologous knee reconstruction which offers longer viability and reliability than its synthetic knee counterparts. Multiple functional muscle unit transfers are required with preservation of distal and proximal innervation to ensure best outcomes and early prosthetic adoption.
Methods
A retrospective review was performed of all patients who underwent rotationplasty at The Ohio State University Medical Center and Nationwide Children's Hospital (2008 to 2018). A multidisciplinary orthoplastics team treated all patients undergoing Van Ness rotationplasties. Intraoperative neuromuscular preservation was confirmed under direct visualization and with a nerve stimulator to isolate major and minor proximal nerve branches to preserve muscle unit transfer functions.
Results
Five patients underwent rotationplasties after oncologic resection over the 10 year period. The average patient age at the time of surgery was 11.75 years. Three patients underwent their procedures within the last 2 years, while the remaining two patients have maintained follow-up for the last 10 years. Four of the 5 patients (80%) have successfully utilized their prosthetics (3 being high functioning sports athletes), while the 5th is currently being fitted for a prosthetic. Minor complications included 2 patients with delayed wound healing requiring secondary closure, and 1 bony nonunion requiring bone grafting to achieve bony union.
Conclusion
The orthoplastic team approach can aid in optimizing the functional outcomes in oncologic rotationplasties.
