Reversal plastic

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Under a reverse plastic is meant an alternative to full amputation in which a part of the body takes on a task for which it is not actually provided. This surgical technique was developed in the 1920s by the doctor Joseph Borggreve as a treatment option after an accident and was later named after him.

Borggreve inverted sculpture

In the case of a disease in the knee or thigh ( e.g. osteosarcoma ), Borggreve reverse plastic surgery serves as an alternative to a complete amputation of the thigh (whereby the active control and stabilization of the knee joint would be lost). The knee and part of the lower leg and thigh are removed, and the lower leg with the foot, rotated 180 ° horizontally, is fixed to the remaining thigh. The ankle joint is set at the level of the knee joint that is no longer present, so that it can take over the task of the diseased knee. The horizontal rotation of the foot backwards is necessary because in the normal position the ankle joint only allows movement forwards and the knee joint only allows movement backwards.

This results in increased mobility and stability compared to a full amputation, which roughly corresponds to that of a lower leg amputation and which can be fitted with a lower leg prosthesis . Above all, the brain then has to be trained in the new control of the limbs, because if you now move the ankle joint of the foot, the prosthetic restoration moves (controlled by the foot) (i.e. the replacement for the lower leg and foot). After appropriate training, a life with very few restrictions is possible; After a few years of running training, ideally, even trained therapists hardly notice any difference in the gait pattern .

In addition, there is usually no phantom pain compared to a normal amputation , since the extremity is not amputated at the end.

As a rule, reverse plastic surgery can only be carried out in the event of illness, as complex planning and preliminary examinations are necessary, which cannot be carried out in the time of an accident, for example. In addition, such an extensive operation (duration 6-10 hours) can only be carried out by a few experts and is possible in medically highly developed countries, as there is an increased risk of infection.

Borggreve inverted plastic has only been performed a few hundred times worldwide. Long after its development, this method was no longer used. In the 1980s Salzer (Vienna), Gersthof and Becker (Volmarstein) and Winkelmann (Düsseldorf) successfully performed this operation in several dozen cases in the treatment of bone tumor patients . The main indication today is for children for whom an endoprosthesis is out of the question due to their age , or patients who have an endoprosthesis - e.g. B. in the event of an infection - had to be expanded.

literature

  • M. Agarwal, A. Puri, C. Anchan, M. Shah, N. Jambhekar: Rotationplasty for bone tumors: is there still a role? In: Clin Orthop Relat Res. 459, 2007 Jun, pp. 76-81. PMID 17414168 .
  • J. Hardes, C. Gebert, A. Hillmann, W. Winkelmann, G. Gosheger: Reverse plastic in the surgical treatment plan for primarily malignant bone tumors. In: The orthopedist. 32 (11), 2003 Nov, pp. 965-970. (Abstract online)
  • W. Winkelmann: Inverted sculpture . In: Winfried Winkelmann (Ed.): Orthopedics and orthopedic surgery. Tumors, tumor-like diseases . Georg Thieme Verlag, 2005, ISBN 3-13-126181-1 , p. 184-189 .

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