Amputation and rotationplasty in children with limb deficiencies: Current concepts

Abstract

PurposeAmputations and fitting surgery have a long history in children with limb deficiencies. With the current developments in limb reconstruction and new techniques in prosthetics, the indications for amputation and fitting surgery might have shifted, but still have a very important role in creating high functional performance, optimal participation and quality of life. The purpose of this current concepts article is to give an overview of the indications, dilemmas and technical considerations in the decision-making for amputation and fitting surgery. A special part of this overview is dedicated to the indications, variations and outcomes in rotationplasties.MethodsThe article is based on the experience of a multidisciplinary reconstruction team for children with complex limb deficiencies, as well as research of the literature on the various aspects that cover this multidisciplinary topic.ResultsFor those children with a more severe limb deficiency, reconstruction is not always feasible for every patient. In those cases, amputation with prosthetic fitting can lead to a good result. Outcomes in quality of life and function do not significantly differ from the children that had reconstruction. For children with a postaxial deficiency with a femur that is too short for lengthening, and with a stable ankle and foot with good function, rotationplasty offers the best functional outcome. However, the decision-making between the different options will depend on different individual factors.ConclusionsAmputations and rotationplasties combined with optimal prosthesis fitting in children with more severe limb deficiencies may lead to excellent short- and long-term results. An experienced multidisciplinary team for children with complex limb deficiencies should guide the patient and parents in the decision-making between the different options without or with prosthesis.

Rotationplasty procedure

“…The best known methods of performing rotationplasty were introduced by the German orthopedist Winfried Winkelmann, and they are: [3,5].…”

“…Then the rectus femoris origin is sutured to the gastrocnemius and the hamstrings origins are sutured to the proximal tibia's extensor retinaculum (fig. 2) [3,5].…”

“…Rotationplasty is a surgical intervention rarely performed. The case often concerns children who suffer from proximal femoral focal deficiency (PFFD) or malignant tumours of the hip joint, the femur, the knee joint and/or the proximal tibia [1][2][3]. In this procedure a proximal part of the lower limb is removed and a distal part of the lower limb is rotated by 180° and reattached in its place, then the ankle joint functions as the knee joint (fig.…”

Physical function and health-related quality of life in young adults with unilateral congenital lower-limb deficiencies

“…congenital fibular deficiency (CFD), is to achieve an active adult lifestyle with optimal function and as little musculoskeletal pain and complaints, including cosmetic aspects, as possible. 1 For the orthopaedic surgeon, this traditionally implies achieving approximately normal alignment with equal limb length and a normal gait pattern based on full weight-bearing. 2 Most often the goals are achieved surgically by one of two treatment modalities: foot preservation and limb salvage with lengthening procedures; or fitting of prostheses, with or without amputation.…”

Necessity of secondary Syme amputation of the foot after severely destroyed hindfoot injury due to suicidal jump from height in a psychiatric patient: Case presentation and brief review of literature

“…Interestingly, archaeological findings at the northern coastal of Peru suggest that surgical disarticulations in ankle joint similar to Syme's technique could have been performed quite substantially earlier during the Moche culture in the ancient pre-European period (AD 100-750) approximately 1.500 years before Syme's first description, and a ceramic vessel of the Moche culture in the American Museum of Natural History (New York) showing that these patients could already have used orthotic devices for their stumps [71]. The aim of this procedure is that there is a bulky full-weight bearing stump on a broad-based bony support obtaining the plantar heel's flap sensibility which make it possible to stand upright on the stump without an orthotic device for example in a shower or a swimming pool [72,73]. Syme advocated that the calcaneus should be dissected subperiostally from the heel flap, it leaves the heel flap lined with the periost which more readily adheres to the cut surface of the tibia, and so, a posterior displacement of flap can be avoided [74].…”