In order to preserve the functionality of the leg of a young girl with oncology, surgeons removed the middle part of the limb, and the lower part was turned 180 degrees and sewn backwards. The unique intervention was carried out at the Saint Nicholas Children’s Hospital of the First Medical Association of Lviv.
Yulia from Ivano-Frankivsk learned about her dangerous diagnosis of bone cancer the day before her 18th birthday. She hit her foot, went to the doctors and after a thorough examination was diagnosed with stage 2 osteosarcoma. The girl was treated by local oncologists of the Ivano-Frankivsk Children’s Regional Clinical Hospital. Six sessions of chemotherapy were prescribed, but they did not help. The disease progressed and could kill the young girl.
The further spread of an aggressive tumor could be stopped in only one way – to urgently remove the affected femur. But Yuli’s cancer had already spread to the knee joint, so there was talk of amputation of the leg at a high level.
In order to fight for the girl’s quality of life and keep the limb as functional as possible, doctors from three cities: Ivano-Frankivsk, Lviv and Kyiv joined their efforts. After several consultations, they decided to perform a rare operation for Ukraine – rotational plastic surgery. Specialists from four hospitals were preparing for the intervention: Kyiv City Children’s Clinical Hospital N2, Kyiv City Center for Plastic Microsurgery, Ivano-Frankivsk Children’s Regional Clinical Hospital and St. Nicholas First Children’s Hospital of the Lviv Medical Association.
The unique intervention was performed by a multidisciplinary team of doctors from three cities at the St. Nicholas Children’s Hospital in Lviv. First, surgeons removed the bones affected by the sarcoma: this is part of the thigh, lower leg and knee joint. In real time, just during the operation, specialists examined the tissues in the laboratory for malignancy to be sure that they removed the entire tumor – without residue and with sufficient margin. The next stage of the operation is again rotational plastic surgery.
Doctors connected two bones of different diameters – the femur and the tibia, while the latter was turned 180 degrees – with the heel forward. After that, plaster was applied and fixed with a metal plate.
The operation, which is rare for Ukraine, was successful. Yulia has already returned to Ivano-Frankivsk and continues chemotherapy and the fight against the disease. When the leg is finally healed and the girl has more strength, she will be able to work with a physical therapist and develop the leg. Then Yulia will have prosthetics. The function of the removed knee joint will be performed by the foot, thanks to which the girl will be able to get a functional prosthesis and master walking.
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Rotational plastic surgery is a surgical intervention in children who, due to bone cancer, have part of their leg and knee removed. And the lower part of the limb together with the foot is turned 180 degrees and sewn to the femur – backwards. Thus, the foot begins to perform the role of the knee, which allows later to install a functional prosthesis and, as far as possible, to preserve the sensitivity and mobility of the limb.