In-situ hypothermic preservation of the distal limb during thigh and femoral vessel resection and rotationplasty in a child with sarcoma: a case report

Background: The management of pediatric sarcomas of the upper thigh involving femoral vessels is challenging. While rotationplasty offers a valuable functional alternative to amputation, ischemia–reperfusion injury of the re-implanted distal limb may compromise the outcome after this procedure. Hypothermic in situ preservation of the distal limb may reduce ischemia–reperfusion–related complications. Methods: We report on the case of a 6-year-old girl presenting with a sarcoma of the thigh involving the femoral vessels. While performing en bloc resection of the upper thigh and femoral vessels, in-situ hypothermic preservation of the distal lower limb was used. Auto-transplantation of the distal lower limb was then completed with rotationplasty to facilitate further prosthesis adaptation and improve functional outcomes. Results: The postoperative course was uneventful. No ischemia–reperfusion–related complications occurred, and complete skin healing was achieved within 1 week. Histopathological examination of the resected tumor confirmed a good oncological response with clear margins. The patient is alive and well, in complete tumor remission 12 months after the operation, with a satisfactory functional outcome of the rotationplasty. Conclusion: In-situ hypothermic preservation is a simple technique that can reduce ischemia–reperfusion injury during complex thigh resection and auto-transplantation of the distal lower limb. It contributes to a straightforward post-operative course and avoids delays in oncological treatment.