Distal Femur Resection

Distal Femur Resection

Megan E. Anderson

Operative Indications

  • Malignant tumors of the distal femur—wide resection (Figure 42.1)

Alternative Treatments

  • Rotationplasty

  • Above-knee amputation

Positioning (Figure 42.2)

  • Supine

  • Pad prominences (cranium, sacrum, contralateral heel)

    • Long surgery and low body weight often contribute to high risk of decubitus ulcers

  • Small roll behind involved hip to position limb in slight external rotation, nearly neutral

  • Assess leg lengths in this position to restore this with reconstruction

    • Can place electrocardiogram (ECG) electrode on contralateral medial malleolus to aid in palpating under drapes

  • Gel bump to rest foot against with the knee in flexion

  • Drape entire extremity from lower abdomen and femoral triangle to toes

Surgical Approach (Figure 42.3)

  • Anteromedial

  • Extensile

  • Length of incision from below tibial tubercle to 2 to 5 cm proximal to planned bone cut (depending on thickness of soft tissue envelope) (Figure 42.4)

Technique in Steps

Deeper Dissection

  • Incise fascia over vastus medialis (Figure 42.5) (image Video)

  • Keep intact the entire length of wound for later repair

  • Separate from retinaculum in the distal portion of wound (Figure 42.6) (image Video)

  • Lift medial fascia away from vastus medialis (Figure 42.7) (image Video)

  • Finger dissection with cautery for perforating vessels

  • Start to release vastus medialis from medial intermuscular septum (Figure 42.8) (image Video)

  • Extent of soft tissue mass dictates proximity of dissection on the septum to the involved portion of the femur

  • Flex the knee to allow relaxation of neurovascular structures (Figure 42.9)

  • Leave the posterior thigh and knee free

  • Enter Hunter canal with release of adductor tendon insertion (Figure 42.10) (image Video)

  • Release medial gastrocnemius tendon origin to enter the popliteal fossa (Figure 42.11) (image Video)

  • Tendon is usually melded with posteromedial capsule, so if extra-articular resection is needed, release tendon more distal after separating from capsule

Jun 9, 2022 | Posted by in Reconstructive surgery | Comments Off on Distal Femur Resection
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