Amputation–From the Routine to the Rotationplasty

Abstract

Historically, extremity amputation was often the only surgical option for traumatic, infectious, or oncologic conditions. Despite evolution of surgical techniques and reconstructive options leading to successful limb sparing operations, amputation remains a viable and durable intervention for many conditions. The most common amputations are performed in the lower extremity and are due to complications of diabetes, peripheral vascular disease, or trauma. General principles and goals of amputations are to remove the pathology, allow for healing, maintain as much length as possible, and provide a stable base on which to weight bear. The barriers to successful outcomes include phantom pain, prosthetic cost, and short residual limbs resulting in difficulty with prosthetic wear.Musculoskeletal oncology is a specialty that affects all ages and anatomic locations. For malignancy of the pelvis and extremities that require an ablative procedure to attain oncologic control, there can be a variety of considerations and unusual situations resulting in difficulties in rehabilitation and functional restoration. A particularly challenging scenario is a malignancy presenting in the lower extremity of a growing child; in this case, a rotationplasty can provide superior function and durability.There have been advancements for amputees in the form of more sophisticated prostheses and rehabilitation protocols. In addition, there has been increased enthusiasm for surgical techniques reducing phantom pain or allowing for use of a myoelectric prosthesis (targeted muscle re‐innervation) and osseointegrative implants that allow for improvements in prosthetic use.