title: Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18-month-old patient.
abstract: Rotationplasty is a limb-sparing surgical option in lower limb malignancies. Sciatic or tibial nerve encasement has been considered an absolute contraindication to this procedure. We report a case of an 18-month-old girl with a rhabdomyosarcoma that affected the leg and popliteal fossa, with neurovascular involvement. Knee and proximal leg intercalary resection was performed followed by reconstruction with free microvascular rotationplasty and neurorraphy from tibial division of sciatic nerve to sural and tibial nerves, and from saphenous nerve to superficial peroneal nerve. Postoperative course was uneventful and ambulation with a provisional prosthesis was restarted during the sixth week after surgery. Bone consolidation was observed after two months. Eighteen months later, the patient had a good gait pattern with a below-knee prosthesis and had recovered sensation in the whole foot and ankle area. This case shows that rotationplasty with nerve repair may provide a sensate stump, which is vital for successful prosthetic adaptation. We believe it may be considered as an alternative to above-knee amputation in tumors with sciatic involvement.
authors.affiliation: Department of Plastic Surgery and Burns, Hospital Universitario y Politécnico La Fe, Valencia.
authors.forename: Alberto
authors.identifier: http://orcid.org/0000-0003-1345-7416
authors.initials: A
authors.lastname: Pérez-García
authors.affiliation: Department of Traumatology and Orthopedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia.
authors.forename: Marta
authors.initials: M
authors.lastname: Salom
authors.affiliation: Department of Plastic Surgery and Burns, Hospital Universitario y Politécnico La Fe, Valencia.
authors.forename: María Eloísa
authors.initials: ME
authors.lastname: Villaverde-Doménech
authors.affiliation: Department of Traumatology and Orthopedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia.
authors.forename: Francisco
authors.initials: F
authors.lastname: Baixauli
authors.affiliation: Department of Plastic Surgery and Burns, Hospital Universitario y Politécnico La Fe, Valencia.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Simón-Sanz
mesh_terms: D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D000672:Amputation Stumps / Q000601:surgery; D001186:Artificial Limbs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007866:Leg / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012208:Rhabdomyosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D012399:Rotation; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps / Q000637:transplantation*; D016138:Walking / Q000502:physiology; D014945:Wound Healing / Q000502:physiology