Amputation and rotationplasty in children with limb deficiencies: current concepts.
OBJECTIVE
Amputations and fitting surgery have a long history in children with limb deficiencies. With the current developments in limb reconstruction and new techniques in prosthetics, the indications for amputation and fitting surgery might have shifted, but still have a very important role in creating high functional performance, optimal participation and quality of life. The purpose of this current concepts article is to give an overview of the indications, dilemmas and technical considerations in the decision-making for amputation and fitting surgery. A special part of this overview is dedicated to the indications, variations and outcomes in rotationplasties.


METHODS
The article is based on the experience of a multidisciplinary reconstruction team for children with complex limb deficiencies, as well as research of the literature on the various aspects that cover this multidisciplinary topic.


RESULTS
For those children with a more severe limb deficiency, reconstruction is not always feasible for every patient. In those cases, amputation with prosthetic fitting can lead to a good result. Outcomes in quality of life and function do not significantly differ from the children that had reconstruction. For children with a postaxial deficiency with a femur that is too short for lengthening, and with a stable ankle and foot with good function, rotationplasty offers the best functional outcome. However, the decision-making between the different options will depend on different individual factors.


CONCLUSIONS
Amputations and rotationplasties combined with optimal prosthesis fitting in children with more severe limb deficiencies may lead to excellent short- and long-term results. An experienced multidisciplinary team for children with complex limb deficiencies should guide the patient and parents in the decision-making between the different options without or with prosthesis.
Department of Orthopaedic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. r.sakkers@umcutrecht.nl.
Ralph
R
Sakkers
Brain Centre Rudolf Magnus and Centre of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, The Netherlands.
Iris
I
van Wijk
Limb deficiency; Limb deformity; Postaxial hypoplasia; Rotationplasty; Syme amputation