A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

Abstract

Rotationplasty provides stable and durable biologic reconstruction after tumor resection around the knee and renders reliable results, in young patients. However, after resection of the tumor, there is often a mismatch between the circumference of the proximal (femoral) and the distal (tibial) parts. Because rotationplasty includes an intercalary amputation where the ends are readapted, there is always a mismatch of the proximal and distal circumferences of the soft tissue envelope. To facilitate skin closure without tension and to avoid impaired wound healing and subsequent infections, the type of incision is critical and must be carefully planned. We present a new incision technique for rotationplasty about the knee. Half of the difference of the incision length of the proximal and distal circumferences represents the base of the triangle proximally, medially and laterally of the thigh. After adapting both ends, the peak of this flat triangle is distally adapted via a vertical incision which allows it to match unequal circumferences. This technique was used in eight patients, in all of whom the wounds healed uneventfully.

Management of Ipsilateral Fractures After Rotationplasty

“…One factor to consider is the previous incision because it can facilitate or preclude the planned approach. Multiple variations have been described 20 , and this should be carefully assessed before surgery. Although in most cases previous incisions can be used, additional extension or separated approaches may be necessary.…”

Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

“…Initially, the cutaneous approach involved two elliptical circumferential incisions to produce a rhomboidal area of skin to be resected with the tumor mass (29). This approach led to difficulties in closing the incision, with irregularities and scarring discrepancies.…”

Rotationplasty: Beauty is in the Eye of the Beholder

“…Other techniques include 2 transverse incisions with distal triangular projections used to compensate for mismatch and fish mouth incisions. 12–14 …”