Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2023; 11(28): 6877-6888
Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6877
Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults: Two case reports
Zhang-Xin Chen, Xiao-Wei Guo, Hai-Sen Hong, Cong Zhang, Wei Xie, Mo Sha, Zhen-Qi Ding
Zhang-Xin Chen, Xiao-Wei Guo, Hai-Sen Hong, Cong Zhang, Wei Xie, Mo Sha, Zhen-Qi Ding, Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
Zhang-Xin Chen, Zhangzhou Health Vocational College, Zhangzhou 361102, Fujian Province, China
Author contributions: Chen ZX and Guo XW contributed equally to this work; Chen ZX contributed to the conception and design; Ding ZQ contribute to the administrative support; Sha M contributed to the provision of study materials or patients; Chen ZX, Guo XW, Hong HS, Zhang C, and Xie W contributed to the collection and assembly of data; Chen ZX, Guo XW, and Sha M contributed to the data analysis and interpretation; all authors contributed to the manuscript writing and the final approval of the manuscript.
Supported by the Army Logistics Scientific Research Projects, No. CNJ16C013.
Informed consent statement: Both patients provided informed written consent for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mo Sha, MD, Associate Chief Physician, Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, No. 269 Zhanghua Middle Road, Zhangzhou 361102, Fujian Province, China. shamo5@163.com
Received: June 18, 2023
Peer-review started: June 18, 2023
First decision: August 10, 2023
Revised: August 15, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 6, 2023
Abstract
BACKGROUND

Rotationplasty is often performed for malignant tumors, but type BIIIb rotationplasty is rarely reported, and there needs to be more evidence of the procedure and treatment. The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and long-term non-healing infections.

CASE SUMMARY

Case 1: A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh, resulting in a femoral fracture. Despite the use of plates, intramedullary nailing, and external fixators, the femoral bone failed to unite due to infectious nonunion. Multiple operations were unable to control the infection, leaving the patient immobile. We performed a modified tibia-pelvic-constrained hip rotationplasty, utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection. Two years post-surgery, the patient was able to walk with the prosthetic device without any signs of recurring infection. The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society (MSTS), 53 for the Functional Mobility Assessment (FMA), 93 for the Toronto Extremity Salvage Score (TESS), and 56 for the MOS 36-item short form health survey (SF-36). Case 2: A 59-year-old woman presented with liposarcoma in her left thigh. Magnetic resonance imaging revealed tumors in the medial, anterior, and posterior femur muscles, encircling the femoral vessels and nerves. Fortunately, there were no symptoms of sciatic dysfunction, and the tumor had not invaded the sciatic nucleus. After one year of follow-up, the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty. The corresponding functional scores were 63 points for the MSTS, 47 for the FMA, 88 for the TESS, and 52 for the SF-36.

CONCLUSION

Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections. For malignant tumors of the lower extremities without invasion of the sciatic nerve, type BIIIb rotationplasty remains an excellent alternative to amputation. This surgical method may prevent amputation, improve functional outcomes, and facilitate biological reconstruction.

Keywords: Salvage procedure, Type BIIIb rotationplasty, Hemangioendothelioma, Incurable infections, Liposarcoma, Case report

Core Tip: Rotationplasty has been reported primarily as an alternative to amputation for malignant tumors, while reports on type BIIIb rotationplasty have been rarer. Our study suggests that type BIIIb rotationplasty may be an alternative to amputation or extended tumor prostheses in two cases of patients suffering from incurable infections. This surgical method may prevent amputation, improve functional outcomes, and facilitate biological reconstruction.