Modification of the skin incision for the Van Nes limb rotationplasty.

The survival of patients with bone sarcomas has improved dramatically with the advent of modern chemotherapeutic regimens, fostering a present trend toward limb sparing procedures. In skeletally immature patients, prosthetic replacement of resected bones and joints is unrealistic because of continued expected growth in the limbs. A stump-lengthening procedure, the reduction-rotation-plasty, has become a valuable alternative to high above-knee amputation. A rhombus-shaped skin incision around the thigh and calf, originally described by Kotz and Salzer, led to a significant discrepancy of the circumference of the proximal and distal skin borders. A circumferential skin incision at the midthigh and a fishmouth-shaped incision at the upper calf was designed to decrease this disproportion. This incision has been used in five consecutive patients with osteosarcoma about the knee. The cosmetic results were excellent, prosthetic fittings were facilitated, and neither vascular nor wound healing problems were encountered.