Van Nes Rotationplasty in PFFD-Modification of Surgical Technique
IVAN KRAJBICH, M.D., ER.C.S.
Van Nes rotationplasty has been part of the treatment of PFFD ever since its description in the English Literature by Van Nes. However, in spite of obvious theoretical advantages of this procedure over a foot amputation, the Van Nes rotationplasty has gained only limited popularity centered on only a few institutions. The two main criticisms of the procedure are its cosmesis and high incidence of derotation. This paper reports on our attempts to minimize or completely abolish the late derotation and thus make the results of this procedure more predictable.
The leg derotation, in our view, is mainly due to inadequate early rotation and to the fact that after the standard rotation, the muscle envelope winds around the leg in a spiral-like fashion, producing constant derotating force to which a growing skeleton of a young child is particularly susceptible.
We report on a small group of 4 patients where the rotationplasty was carried out entirely through the knee. All the muscles crossing the knee are detached from either their origin on the distal femur or their insertions on proximal tibia. The femur and tibia are then shortened enough to allow for 180 degree rotation without undue stress on the neurovascular structures. No osteotomy through the tibial diaphysis is required. In two of these patients, we used a circular, circumferential incision to improve exposure and to improve ease and cosmesis of the skin closure. To date, we have had no late derotation and no skin healing problem. We feel this modification of the surgical technique allows the rotationplasty results to become more predictable.
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