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PubMed1985

CT evaluation of the pelvis after hemipelvectomy.

From examination of 69 pelvic CT scans from 25 patients, the role of CT after hemipelvectomy is examined. A brief description of the various types of hemipelvectomy, including simple, extended, compound, and modified, is presented. The new variants of internal and modified internal hemipelvectomy are also included. The normal post-surgical changes in the musculoskeletal structures and pelvic viscera are described and illustrated. Postoperative abnormalities detected included hematoma, inflammatory changes, incisional hernia, ureteral obstruction, adenopathy, and local recurrence. An example of the usefulness of CT in CT-guided biopsy and CT-guided thermocouple placement is provided. CT of the pelvis is advocated as the method of choice to follow these patients, because of its ability to detect postoperative recurrence and complications.

Adolescent↗
PubMed1989

Traumatic hemipelvectomy: a catastrophic injury.

Traumatic hemipelvectomy is a catastrophic injury resulting from violent blunt shearing forces which cause massive skin, bone, and soft-tissue destruction. The initial extent of the injury as well as the complexity of the consequent problems is staggering. As such it constitutes one of the major challenges seen by trauma surgeons. Patients surviving traumatic hemipelvectomy are rare. We found a total of 36 cases reported in this century. The University of California at Davis General Surgery Trauma Service admitted 9,369 major trauma victims from June 1985 to May 1988. During this 3-year period eight patients sustained a traumatic hemipelvectomy, of whom three survived. Given the complexity, yet rarity, of this injury, a review of the world literature was undertaken to compile collective experiences to aid surgeons in the management of this injury.

Adolescent↗
PubMed1988

Modified hemipelvectomy: conservation of the upper iliac wing and an anterior musculo-cutaneous flap.

Very large bone and soft tissue tumors located in the pelvis or upper thigh may require hemipelvectomy if local excision is not possible. Classical hemipelvectomy is associated with a high risk of local complications and usually with a poor functional result. This paper describes a modified hemipelvectomy where the preservation of the upper iliac wing provides a counterpressure for the external prosthesis, and a vascularized anterior musculo-cutaneous thigh flap decreases the risk of skin necrosis and wound problems.

Adult↗
PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗
PubMed1975

Hemipelvectomy.

Hemipelvectomy was performed in 50 patients with malignant neoplasms of the upper part of the thigh and pelvis. Although not technically difficult, the operation is associated with considerable blood loss. Postoperative complications are frequent, the greatest morbidity resulting from skin flap necrosis. Symptomatic phantom limb is as occasional late problem. Of 37 patients resected for cure prior to 1969, 14 were alive five or more years postoperatively. Five of these long-term survivors subsequently died of metastases. Patients with fibrosarcoma and chondrosarcoma had the best survival. Six other patients underwent palliative hemipelvectomy for intractable pain, with gratifying results. Hemipelvectomy is an important, useful operative procedure in selected patients.

Adolescent↗
PubMed1988

The external oblique myocutaneous flap for extended hemipelvectomy reconstruction.

This article documents the first case report of an extended hemipelvectomy defect closure using an ipsilateral external oblique myocutaneous flap. When a hemipelvectomy usually is performed for soft tissue tumor ablation, an anterior or posterior flap can be preserved for immediate coverage of vital structures. When these flaps are also resected to obtain clear tumor margins, closure becomes difficult. In our patient, although the rectus myocutaneous flap was a next logical choice, prior surgical scars precluded it use. The external oblique flap was successfully rotated and solved a difficult problem. This flap should be considered when the rectus abdominis myocutaneous flap is unavailable for extended hemipelvectomy closures.

Abdomen↗
PubMed1996

Internal hemipelvectomy.

Until recently, tumours involving the pelvis were usually treated by hemipelvectomy, otherwise called "hindquarter amputation". A more recent approach of treating these tumours is the 'conservative hemipelvectomy', which consists of removing the tumour and sparing the lower extremity. A patient with Ewing's sarcoma of the pelvis underwent such a procedure. The femoral head was fixed temporarily to the remaining parts of the acetabulum and the iliac wing by a Steinman pin. The Steinman pin was removed 6 weeks after the operation and the patient was then put into traction for another 6 weeks. Weight-bearing was gradually allowed after 3 to 6 months. The patient remodelled a neoacetabulum, which gave sufficient stability to the hip joint. Walking without external help was possible. The patient presented with a 2 cm limb-shortening. No local recurrence was observed during a follow-up of 30 months. This experience with internal hemipelvectomy shows an encouraging result in terms of tumour control and gait function.

Adult↗
PubMed1975

[Hemipelvectomy and its anesthesiological management].

Based on the study of an operative course, anesthesia and immediate postoperative period in 63 patients subjected to hemipelvectomy, it is demonstrated that the danger of early complications in these cases, at present, is not great relatively, and such operations can and must be performed, if indicated. Moreover, hemipelvectomy produces a number of specific changes in the organism that should be taken into consideration in conduction of anesthesia and corrective therapy postoperatively. Ganglionary blockade seems to be an obligatory constituent of anesthesiological provision in hemipelvectomy.

Adolescent↗
PubMed1982

The total thigh and rectus abdominis myocutaneous flap for closure of extensive hemipelvectomy defects.

Hemipelvectomy is a lifesaving procedure when used appropriately and yields a 35%, five-year survival in the cancer patient. However, the standard posterior flap for closure is not always available. Two flaps, the thigh flap and the rectus abdominis myocutaneous flap, are described in which any soft tissue defect resulting from hemipelvectomy can be safely closed primarily when the posterior flap is not available. The total rectus abdominis flap is previously undescribed and unique in its application. These techniques significantly contribute to the surgeon's armamentarium for decreasing morbidity and mortality and resectability of unusual pelvic and thigh tumors.

Abdominal Muscles↗
PubMed1979

Total "internal" hemipelvectomy.

Several authors have described resections of tumorbearing parts of the pelvis including reconstructive plastic surgery. With extensive tumor growth present mutilating hemipelvectomies often have been the last resort. Even the most sophisticated prostheses hardly ever enabled the patients to walk again. We have therefore performed total "internal" hemipelvectomies in three cases. The necessary substitute consisted of half a pelvis made of polyacetal resin produced from a given model. The model's measures and shape was established by computer tomograms thus resulting in an individually shaped pelvis half. The operative procedure aims at the maintenance of osseous muscular insertions and origins and their reconstruction. Utmost care has to be taken in avoiding damage to nerves and vessels. Fixation of the implant is performed by screws aiming through the sacroiliac joint into ala and corpus of the sacrum and corticocancellous grafts incorporated in the implant. The symphyses are united by means of plate fixation. The hip joint is substituted by a total prosthesis. With the procedure described we have managed three cases of extensive malignant tumors of the pelvis. One patient suffered a nerve lesion and skin necrosis with infection. The two remaining patients are capable of weight-bearing and standing on the inflicted leg alone.

Adolescent↗
PubMed2006

[Traumatic hemipelvectomy].

With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.

Adolescent↗
PubMed2001

[Traumatic hemipelvectomy and postoperative quality of life. Report of 2 cases 18 years after trauma].

Report and progress of 2 traumatic hemipelvectomies in motor-cyclists with excluding extraperitoneal tearing of half of the pelvis and disrupture of the pelvic vessels for 18 years. The purpose of this case study was the analysis of the quality of life, the clinical complications and the reintegration of the 2 patients 18 years after traumatic hemipelvectomy.

Activities of Daily Living↗
PubMed2005

Traumatic hemipelvectomy: case report and literature review.

Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival.

Accidents, Traffic↗
PubMed1983

Variants of hemipelvectomy.

Anterior flap hemipelvectomy is used for large, fixed tumors in the area of the buttock. The anterior flap consists of skin, subcutaneous fat, fascia lata, and the mobilized femoral vessels attached to the flap. It is accomplished by dividing the profunda femoris vessels. In routine posterior flap hemipelvectomy, a long flap can be constructed, if necessary, reaching to the level of the umbilicus. The viability of the posterior flap is assured by leaving the gluteus maximus muscle attached to it.

Amputation, Surgical↗
PubMedDate not supplied

Case study: traumatic hemipelvectomy.

Open pelvic fractures have a greater than 40% mortality rate. Traumatic hemipelvectomy, a severe form of open fracture, is a life-threatening injury that requires rapid resuscitation, surgical intervention, and critical-care monitoring. Survivors benefit from aggressive and consistent rehabilitation. This case presentation discusses the multiple aspects of care of a traumatic hemipelvectomy and the ways in which the staff were able to accommodate the cultural needs of an Amish patient and family.

Adolescent↗
PubMed2003

Use of the Ilizarov technique to improve limb function following hemipelvectomy.

AIMS: Limb salvage surgery combined with tumour resection has become established in the management of pelvic tumours. However, subsequent reconstructive options for maintenance of quality of life lead to varied outcomes. We present a hitherto undescribed use of the Ilizarov technique as a second stage adjunct, for the optimisation of function, after first stage tumour resection and arthrodesis. METHODS: We describe the surgical technique used to address leg length discrepancy and abductor dysfunction following internal hemipelvectomy with ischifemoral arthrodesis. Distal femoral and distal tibial lengthening using circular frames, with a valgus subtrochanteric femoral osteotomy, enabled a rapid correction of both anomalies. Controlled varus correction at the distal femoral osteotomy site was performed to obtain a horizontal joint line at the knee. CONCLUSION: The Ilizarov technique is suitable for selected patients with tumour free survival following the initial resection. Our experience indicates that it is a good alternative to a mammoth one stage internal hemipelvectomy with reconstruction. The latter is often attempted even though there is a high risk of local recurrence and distant metastasis.

Adult↗
PubMed1989

Internal hemipelvectomy as a treatment for end-stage pressure sores.

Internal hemipelvectomy was used to treat recalcitrant pressure sores in the absence of flap options following leg fillet. The bony hemipelvis was resected in the subperiosteal plane, resulting in the removal of the iliac wing, ischium, and pubic rami. This procedure creates enough mobile soft tissue to allow even large ulcer defects to be closed primarily. We have used the technique successfully in 5 patients; follow-up ranged from 4 to 30 months. Internal hemipelvectomy is a treatment option for end-stage pressure ulcers in lieu of hemicorporectomy.

Adolescent↗
PubMed1992

Popliteal-based filleted lower leg musculocutaneous free-flap coverage of a hemipelvectomy defect.

A 33-year-old man suffered from locally recurrent malignant fibrous histiocytoma of his left thigh unresponsive to previous excision, radiation therapy, chemotherapy, and hyperthermic treatment. He underwent radical hemipelvectomy for cure. Because of extensive tumor involvement, a free flap consisting of his distal left leg based on the popliteal artery was utilized to close the defect. Both the tibia and fibula were removed from their periosteal sheaths, and the foot was excised from the flap. The popliteal artery and vein were anastomosed to the iliac vessels. The flap survived, and the patient was discharged home after physical rehabilitation. We suggest that uninvolved portions of the distal leg may be utilized as a free flap to successfully close hemipelvectomy defects in selected patients when conventional pedicle flaps are unavailable.

Adult↗