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.
Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
James R. Neff—Deceased.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent was obtained.