Abstract
Rotationplasty, or the Van Nes procedure, is a surgical option for reconstruction of the lower extremity after resection of a malignant bone tumor in predominantly skeletally immature patients. The procedure usually involves resection of the femur and knee joint en bloc. Virtually all soft tissues, including skin around the tumor, are excised, and the sciatic nerve is preserved. The vessels can be resected and re-anastamosed or preserved. The leg and foot are rotated 180 degrees and reattached, preserving and/or restoring the nerves and blood supply. The foot and ankle which face posteriorly, then function as a knee joint in a custom-made prosthesis.
Although this procedure has been successfully performed for many years, patients and families cite cosmesis as a major consideration when making this decision. The lack of knowledge and understanding of the functionality, the psychosocial adjustment, and the quality of life with the rotationplasty, also, present challenges for families with respect to acceptance of this surgical choice.
Two case studies will be discussed to demonstrate the biopsychosocial elements of this procedure. These two individuals, 2.5 years and 24 years post-rotationplasty respectively, have attained success in their personal and professional lives, and they have willingly and enthusiastically shared their experiences with patients and families considering this surgical option. Using Roy’s adaptation model, this presentation will focus on adopting positive role modeling to enhance adaptive strategies needed by patients and families to guide their decision making.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
