Microsurgical Transfer of the Proximal Tibia, Including Epiphysis, in the Management of High above Knee Amputations

The management and outcomes from treatment of femoral sarcoma are well documented. This involves oncological resection and either limb preservation with reconstruction, or above knee amputation (AKA).[1]

Diaphyseal limb amputations in children are associated with high stump morbidity because of bone spiking, with primary revision rates of 43% documented.[2]

Another alternative is the rotationplasty.[3] [4] This procedure utilizes the distal part of the amputated limb, including the ankle joint with preservation of the sciatic nerve. The remaining sensate foot, is fitted for a prosthesis reproducing a below knee amputated limb functionally.

• References

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• 2 O'Neal ML, Bahner R, Ganey TM, Ogden JA. Osseous overgrowth after amputation in adolescents and children. J Pediatr Orthop 1996; 16 (1) 78-84
• 3 Winkelmann WW. Rotationplasty. Orthop Clin North Am 1996; 27 (3) 503-523
• 4 Forni C, Gaudenzi N, Zoli M , et al. Living with rotationplasty—quality of life in rotationplasty patients from childhood to adulthood. J Surg Oncol 2012; 105 (4) 331-336
• 5 Wang GJ, Baugher WH, Stamp WG. Epiphyseal transplant in amputations. Effects on overgrowth in a rabbit model. Clin Orthop Relat Res 1978; (130) 285-288
• 6 Brown K, Marie P, Lyszakowski T, Daniel R, Cruess R. Epiphysial growth after free fibular transfer with and without microvascular anastomosis. Experimental study in the dog. J Bone Joint Surg Br 1983; 65 (4) 493-501
• 7 Innocenti M, Delcroix L, Romano GF. Epiphyseal transplant: harvesting technique of the proximal fibula based on the anterior tibial artery. Microsurgery 2005; 25 (4) 284-292
• 8 Cormack GC, Lamberty BGH. The arterial anatomy of skin flaps. 2nd ed. Edinburgh: Churchill Livingstone; 1994: 498-504
• 9 Hallock GG, Anous MM, Sheridan BC. The surgical anatomy of the principal nutrient vessel of the tibia. Plast Reconstr Surg 1993; 92 (1) 49-54
• 10 Hannouche D, Duparc F, Beaufils P. The arterial vascularization of the lateral tibial condyle: anatomy and surgical applications. Surg Radiol Anat 2006; 28 (1) 38-45