Rotationplasty - A new hope!

 Cancer is a disease that has crippled people for centuries. Be it mentally, physically or emotionally. Hearing someone being diagnosed with Cancer is itself more tragic than the disease itself; the whole family is suffers from cancer and its effects. Especially those who have seen neurological cancers; their whole life is centred around that person. 

Early diagnosed cancers are a blessing because they can be treated surgically or by drugs, but those that are asymptomatic for a long period of time and then occur suddenly with clinical presentation, are most problematic as people tend to lose the functionality of the part where it occurs, or they either die because of the severity, but a few survive by battling it, and pediatric age group is most important age group where a cancer can mean life and death situation.

Pediatric cancers generally occur in bone, blood or CNS. Majority of them occur in form of leukaemia, lymphoma, or Bone marrow pathology, sometimes osteosarcoma may be also seen. Treating them with medications can act like a double edged sword if the age group isn't considered as the primary.

A new surgical technique called as Rotationplasty is being practiced these days which result in better lifestyle of the patient.

Rotationplasty -   Rotationplasty is a functional surgical procedure for children undergoing resection of a malignant bone tumor around the knee joint.

Indications for Rotationplasty -    Malignant tumors in distal femur, Osteosarcoma, Ewing's Sarcoma, Infected Prosthetic implants, Congenital limb deformities, etc.

Prerequisites - Before opting for the procedure, there are a few important points that are considered and explained to the patient's family. The points that are needed to be explained are - 

Cosmetic changes will be seen in the limb.

Amputation will be done for the procedure to work.

Physiotherapy is to be done in order for good recovery.

Prosthetic to be added so as to live a healthy life.

Surgery - The surgery takes approximately 6-10 hours to complete. The procedure is very simple, but difficult to perform. The doctor marks the initial site after localising the cancer. Generally this is carried out when the tumor is near the knee joint. The ultimate goal of life is to maintain maximum range of motion and to give the normal lifestyle back to the patient with highest performance. Two sites are marked, 1st site is near the proximal pole of the tumor, and the next site is marked 2-5 cms prior to ankle joint. The in-between part is removed and the structures to be preserved are - arteries that go to the ankle, veins that go to back to the femoral vein, and the sciatic nerve with its branches.

On doing so there is a benefit, that healing is better and there is less chance of wound infection. After this, the ankle and the remaining foot is rotated 180 degrees and then attached to the thigh (As seen in the images below).

The site is identified

The patient is made to lie down on the table and the sites are marked.

The limb is removed as it is done in amputation, except the neurovasculature that helps in the movement of the muscles and joints.

The ankle is rotated 180 degrees.

It is then sutured to the rest of the thigh,

Doing this will make one important thing. As the operation is complete the levels of the knee and the rotationplasty will defer.

But as the child grows, the lengths will match.

This eventual matching of the length will make the ankle turn into a knee joint of the operated part. Thus when the prosthetic which is made specially for this procedure is fitted, the person can resume normal work, like nothing has happened.

Post-operative care - Following surgery the child is admitted to ICU for 24-48 hours. This is done to ensure there is sufficient blood supply to the ankle and there is no infection or sepsis. Cast is applied to the area after the healing to promote bone healing and adherence. Once the bone and skin is healed along with the adequate blood supply, the child is cleared for prosthetic usage.

As the prosthetic is fitted, the child is supposed to take physiotherapy, so that he/she gets used to the prosthetic added and also there is normal motion of the limb while sports activity.

Complications - Unlike other surgeries, there are complications here which may lead to - Sepsis, decreased blood flow to the ankle, delayed wound healing, neuronal damage leading to nerve insensitivity, malunion of the bones leading to additional joint appearance and cosmetic changes leading to multiple surgeries to correct.