title: 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.
authors.affiliation: The Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA. iowamahoneymd@aol.com
authors.forename: Craig R
authors.initials: CR
authors.lastname: Mahoney
authors.forename: Curtis W
authors.initials: CW
authors.lastname: Hartman
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Simon
authors.forename: B Timothy
authors.initials: BT
authors.lastname: Baxter
authors.forename: James R
authors.initials: JR
authors.lastname: Neff
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D000842:Ankle / Q000098:blood supply; D001794:Blood Pressure; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001916:Brachial Artery / Q000503:physiopathology; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D009361:Neoplasm Invasiveness; D019637:Orthopedic Procedures / Q000379:methods*; D012189:Retrospective Studies; D012399:Rotation; D013977:Tibia / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects