Blood vessel transfer allowing avoidance of surgical rotation or amputation in the management of primary malignant tumors of the knee
Wuisman, P.; Grunert, J.
Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur 80(8): 720-727
1994
ISSN/ISBN: 0035-1040 PMID: 7638401 Document Number: 435715
The surgical and clinical outcome of a limb-salvaging technique for tumors about the knee utilizing autogenous vessel transfer is reported. The original indication for these lesions was amputation or Van Nes rotationplasty because of vascular encasement by the tumor. Twelve patients are reported: seven females and five males with an average age of 16 years. There were nine distal femur and three proximal fibula stage IIB primary malignant tumors. All patients underwent a local wide resection of the primary tumor including the main vessels, followed by local reconstruction of the bone and vessels by an ipsilateral vessel transfer. Postoperatively the limbs were immobilized in a cast and the patients were treated with intravenous Heparin, followed by a single low dose Heparin injection for three months. Immediate postoperative arterial occlusion in one patient was successfully treated, but eight weeks later another occlusion occurred and an amputation was necessary. In another patient, arterial thrombi necrotized two toes; they were subsequently amputated. Other local complications were hematoma (two patients), superficial skin necrosis (one patient), and deep infection (one patient). All were successfully revised surgically. All resections obtained negative margins, and there were no local recurrences or distant metastases. In all twelve patients the tumor either encased the artery and vein, or the pseudocapsule of the tumor touched the vascular adventitia. The results show that by patients in whom there is attachment of the tumor with major vessels or in whom the vessels are encased by the tumor, wide limb-saving resection can be achieved by en-bloc resection of the primary tumor and the vessels. In this respect a contamination of the vessels is no longer a contra-indication for a limb-saving procedure. The described method is safe, has a relatively low complication rate comparable with rotationplasties and allows a limb-saving procedure.