Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18‐month‐old patient

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 neurova...

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Bibliographic Details
Published in:Microsurgery 2017-05, Vol.37 (4), p.344-347
Main Authors: Pérez‐García, Alberto, Salom, Marta, Villaverde‐Doménech, María Eloísa, Baixauli, Francisco, Simón‐Sanz, Eduardo
Format: Article
Language:English
Subjects:
Amputation
Amputation - methods
Amputation - rehabilitation
Amputation Stumps - surgery
Ankle
Artificial Limbs
Bone surgery
Case reports
Casing (process)
Consolidation
Feet
Female
Follow-Up Studies
Gait
Humans
Infant
Knee
Leg
Leg - pathology
Leg - surgery
Magnetic Resonance Imaging - methods
Microsurgery
Microvasculature
Nerves
Peroneal nerve
Prostheses
Reconstructive Surgical Procedures - methods
Repair
Rhabdomyosarcoma
Rhabdomyosarcoma - diagnostic imaging
Rhabdomyosarcoma - surgery
Rotation
Saphenous nerve
Sciatic nerve
Soft Tissue Neoplasms - diagnostic imaging
Soft Tissue Neoplasms - surgery
Surgical Flaps - transplantation
Tibial nerve
Tumors
Walking - physiology
Wound Healing - physiology
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Summary: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.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.30147