Rotationplasty surgery is a specialized procedure to remove the leg from above the knee. The foot and ankle are rotated and reattached to the remaining part of the leg
Jennifer Pascual, like most teens, has many interests. The 13-year-old, who lives in Southern Indiana, enjoys spending time with her large family. She loves animals and has many pets. She likes to draw and paint, play music and sing.
“I’m learning to play the ukulele,” she said. “It’s really fun.”
Unlike most teens, however, Jennifer has a type of bone cancer called osteosarcoma. Osteosarcoma is relatively rare, yet it is the most common form of bone cancer among children and teens.
Kerry K. McGowan, M.D., pediatric oncologist/hematologist with Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine, is Jennifer’s main cancer doctor. She said nationwide, only about 400 new cases of osteosarcoma are diagnosed annually.
Dr. McGowan first saw Jennifer in December 2019 when she was admitted to Norton Children’s Hospital after seeing her pediatrician for persistent burning pain in her right leg. Tests soon confirmed osteosarcoma in her femur.
“It’s never easy to tell a family their child has cancer,” Dr. McGowan said. “When I told the Pascuals Jennifer’s diagnosis, she was a positive force within her family. She set the tone of ‘We’ve got this.’”
In April 2020, Jennifer was scheduled for rotationplasty, a specialized surgical procedure to remove the leg from above the knee. The foot and ankle are then rotated and reattached to the remaining part of the femur.
The repositioned ankle takes on the job of a knee joint. This gives the patient more potential for flexibility and function once they are fitted with a prosthesis.
According to Dr. McGowan, the rotationplasty, paired with today’s advanced prostheses, can greatly improve outcomes.
“Patients can function well in daily living and even enjoy activities such as sports or dancing,” she said.
As the time for Jennifer’s surgery neared, she enjoyed working with art therapist Laura Chamberlin. Painting helped her stay busy and express her feelings.
One day Laura showed Jennifer some photos of famed artist Frida Kahlo, whose right leg was amputated due to childhood polio and a later injury. Jennifer was inspired by Kahlo, who painted bright flowers on her prosthesis.
Jennifer thought, “Lots of people have bad things happen but still do great things, and so can I.”
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Rotationplasty surgery is one step in osteosarcoma recovery
Jennifer has continued to recover since leaving the hospital in October 2020. She sees Dr. McGowan for regular checkups.
Dr. McGowan said the time after rotationplasty surgery can be a hard time for young patients, who typically get a second round of chemotherapy for 18 weeks following surgery. That’s in addition to the 10 weeks of chemotherapy before surgery. At the same time, they have to get used to a new way of moving.
“Surgery is not the last step but an in-between stop in a long process. Transitioning to full use of a prosthetic is a multistage process,” she said, adding that thankfully kids often show surprising resilience.
“Jennifer has shown she is a very strong person from day one,” Dr. McGowan said. “She has come a long way and is heading toward that final stage with her prosthetic.”
Jennifer is happy about “graduating” to crutches and having less need for a wheelchair or walker. She is working on “training her brain” and building confidence to put weight on her prosthesis.
She is not shy or worried about going out in public. She is eager to travel and visit family she has not seen in a long time.
“I’m moving forward and concentrating on my overall health,” Jennifer said.