Rotationplasty in segmental resections of the femur.

The authors report 26 cases of high-grade malignant tumors of the distal femur (23 osteosarcomas, 3 Ewing's tumors) submitted to rotation-plasty. The five-years actuarial survival rate (in the 23 cases of osteosarcoma) was 69% and there was no incidence of local recurrence. The following complications were observed: wound dehiscence (6 cases), arterial thrombosis (in 2 patients submitted to resection and vascular termino-terminal suturing), paralysis of the sciatic nerve (2 cases), delay in consolidation (2 cases), traumatic fracture of the neo-femur (3 cases). All of the complications were resolved favorably, 5 of these requiring surgical treatment (33%). Satisfactory functional results were obtained in all of the cases, except in one patient who had limitation of the ankle joint subsequent to vascular compartmental syndrome. On the basis of the oncological, functional and biomechanical results reported in this study and in the literature, the authors discuss current indications for rotation-plasty.     

A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

Rotationplasty provides stable and durable biologic reconstruction after tumor resection around the knee and renders reliable results, in young patients. However, after resection of the tumor, there is often a mismatch between the circumference of the proximal (femoral) and the distal (tibial) parts. Because rotationplasty includes an intercalary amputation where the ends are readapted, there is always a mismatch of the proximal and distal circumferences of the soft tissue envelope. To facilitate skin closure without tension and to avoid impaired wound healing and subsequent infections, the type of incision is critical and must be carefully planned. We present a new incision technique for rotationplasty about the knee. Half of the difference of the incision length of the proximal and distal circumferences represents the base of the triangle proximally, medially and laterally of the thigh. After adapting both ends, the peak of this flat triangle is distally adapted via a vertical incision which allows it to match unequal circumferences. This technique was used in eight patients, in all of whom the wounds healed uneventfully.     

Rotationplasty as a reconstructive operation after tumor resection

Reconstruction in the skeletally immature patient following resection of osteosarcoma about the knee is a challenging problem. Salvaging of the limb with allogeneic or prosthetic replacement results in a shortened limb with functional limitations. Arthrodesis yields a stiff and shortened limb. The so-called growing prosthesis has a high complication rate and is still unproven. However, rotationplasty has been successfully used as a reconstructive technique following resection of these types of tumors in the skeletally immature patient. A limb with normal sensation and proprioceptions, adequate range of motion, and without leg-length discrepancies, functional limitations, or painful neuroma is to be expected. Although a prosthesis must be worn, these patients are active and participate in unrestricted physical activity. Cosmetic acceptance has not been a problem and complications are minimal. Thus, rotationplasty requires only a single operation and results in a highly functional limb.     

膝关节旋转成形术治疗儿童股骨骨肉瘤

目的：介绍并讨论膝关节旋转成形术治疗股骨骨肉瘤的方法和随访结果。材料和方法，对4例股骨远端的骨肉瘤患儿施行了肿瘤广泛局部切除，膝关节旋转成形术，其中女1例，男3例，平均年龄10岁，平均随访3年。结果：目前所有病例均成活，肿瘤局部无复发，术后佩戴义肢，下肢的负重和运动功能好。结论：踝关节代替膝关节旋转成形术对于膝关节周围的原发恶性肿瘤、肿瘤术后局部复发等也是另一种有效的手术治疗方法。     

Management of Vascular Infections in the Groin

Annals of Vascular Surgery -     

Critical Issues in Management of Congenital Vascular Malformation

Congenital vascular malformation (CVM) has long been a challenging problem. Recently, a new classification of CVMs was launched, opening up a new era. This improved definition provides critical information on CVM etioanatomopathophysiology. Advanced diagnostic technology has also provided more accurate and safer diagnosis. Finally a new, improved method of managing CVMs based on a new, multidisciplinary approach has emerged. In this study, various noninvasive diagnostic tests were adopted for contemporary diagnosis, and invasive studies were reserved for use as a road map for treatment. A new treatment strategy evolved, following proper identification of absolute and relative indications for treatment, which integrates surgical therapy and embolosclerotherapy. Three hundred and sixty-two patients selected for treatment, among a total of 1007 patients with various indications, were retrospectively reviewed. Various embolosclerotherapy techniques were performed on 333 patients, including 640 sessions of ethanol-based therapy. The immediate success rate was excellent (96.2%) but was accompanied by various complications mostly of a minor nature during 212 sessions (22%). The interim results were also excellent, with no evidence of recurrence. A total of 102 patients underwent 128 surgical procedures, consisting of a variety of different therapies, either independently (29/102) or in conjunction with preoperative embolosclerotherapy (73/102). Most of the interim results were excellent (111/128). The use of a complex therapy regimen through a multidisciplinary approach leads to a more manageable and satisfactory outcome.     

Rotationplasty as a limb salvage procedure for malignant bone tumours

Summary. Sixteen patients with malignant bone tumours, 15 osteosarcoma and one Ewing’s sarcoma, were treated by rotationplasty at Tata Memorial Hospital between 1989 and 1994. The functional results are better than after amputation.

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Résumé. Les auteurs rapportent 16 cas de tumeur osseuse maligne traités par plastie de rotation à l’H?pital Tata Memorial entre 1989 et 1994. Il s’agit de 15 ostéosarcomes et d’une sarcome d’Ewing. Avec une bonne rééducation prothétique les résultats donnent une meilleure qualité de vie que ceux apportés par une amputation.

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Accepted: 10 July 1997     

Rotationplasty after failed limb-sparing tumor surgery: a report of two cases

Rotationplasty was used in two cases of failed limb salvage in adults after tumor resection and reconstruction. Each patient had distal femoral osteosarcoma, one treated with osteoarticular allograft reconstruction, the other with a custom endoprosthetic reconstruction. Both patients had failure attributable to infection, and after multiple surgeries, elected to have rotationplasty. Both had complications associated with the rotationplasty but went on to have functional limbs with Musculoskeletal Tumor Society functional scores of 67% and 87%. One patient died of metastatic disease 29 months after rotationplasty, the other had no problems 50 months after rotationplasty. Although rotationplasty offers a functional improvement over transfemoral amputation in the salvage of failed tumor reconstructions, only 10 such cases have been reported in adults. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery.     

Rotationplasty type B IIIa according to Winkelmann: electromyography and gait analysis

After resection of a malignant bone tumor of the femur, rotationplasty is considered a treatment option in addition to other limb salvage procedures such as endoprosthetic replacement, allograft, or autograft reconstruction. A Type B IIIa rotationplasty is indicated when the tumor involves the total femur or when skip lesions are detected. After the total femur is resected, the lateral tibial plateau is placed into the acetabulum after rotating the tibia and foot segment 180 degrees. Eight patients at an average age of 5.9 years underwent a rotationplasty Type B IIIa at the authors' institution. After a median followup of 59.6 months (range, 24-86 months) the clinical results were excellent and the functional status according to the criteria of the Musculoskeletal Tumor Society was good (23 of 30 points). In electromyographic analysis the muscle activity of the affected leg revealed good function of the stance and the swing phase muscles according to their new function with comparable amplitudes to the unaffected limb. The kinematics (range of motion of the hip and knee) were slightly assymmetric. Gait analysis showed a slight lateral trunk lean over the ipsilateral limb with reduced joint moment. All patients had full weightbearing ability. Remodeling of the tibial plateau into a round form mimicking a new femoral head is confirmed by radiographs and magnetic resonance imaging scans. In young children with a tumor of the total femur, rotationplasty Type B IIIa is a good treatment modality with excellent clinical and good functional results. The electromyographic and gait analysis data underscore a good functional restoration of gait after rotationplasty.     

四肢主干血管损伤的处理(附39例报告)

目的　对 39例主干血管损伤进行回顾分析。　方法　本组共 39例 ,急诊病人 31例 (开放损伤 2 7例占87% ) ,晚期损伤 8例 ,采用血管移植、直接吻合等方式处理。　结果　平均随访 2 0 4个月 ,修复血管通畅率为 92 3 % ,2例因术后血运障碍二次手术无效而二期截肢 ,1例因术中过度失血死亡。　结论　强调早期诊断和早期治疗此类损伤是成功的关键 ,对诊断明确或高度怀疑有血管损伤者应立即手术探查 ,血管端端吻合、血管移植是首选的手术方法。对晚期血管损伤应争取修复血管以改善肢体循环