Hindquarter Amputation - Ian Holloway 13/5/2002

Interinnominoabdominal amputation,

interilioabdominal amputation,

ilioabdominal amputation,

transiliacamputation,

transpelvic amputation,

hemipelvectomy


Indications

Mostly for malignancy (boneor soft tissue sarcoma) arising from the hip or femur such that limb salvage surgery or disarticulation is not possible.

Previously was used forinfection (eg TB)

Trauma – several casereports in the literature.


Preop preparation

Enemas, catheter, XM 10units

Blood conserved by use of Esmarch unless embolisation is a risk (? Venogram)


Positioning

True lateral

Use sling to suspend foot


Incision

Anterior incision: starts atpubic tubercle; swings superiorly and laterally along inguinal ligament; alongcrest of ilium.

Posterior incision:continues distally and anteriorly around greater trochanter; then posteriorly and medially along gluteal fold, then superiorly between perineum and adductors.


Posterior flap

Includes gluteus maximus

Most authors recommend that internal illiac vessels must be preserved to avoid flap necrosis

Bleeding from the internal iliacs can be high. Some authors recommend tying the common iliacs.


Complications

Wound complications: flapnecrosis, wound infection

Tumour embolisation

Urinary fistula


Post op management

Prosthesesare available but often badly tolerated

Patientsoften prefer life on crutches


Brief

Gordon-Taylor British Journal of Surgery 1935

Authors

G Gordon-Taylor, P Wiles

Title

Interinnomino-abdominal (hinquarter) amputation

Reference

BJS 1935;22:671-695

Summary

Retrospective review of authors’ series of 5 cases. Case reports.

Critique

Historical article. Gives extensive clinical, operative and pathological details of each case. Operative technique described. Reviews all previous cases.

Brief

Masterson Clinical Orthopaedics and Related Research 1998



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