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- W148621666 abstract "OverviewIn spite of increasingly effective chemotherapy and advances in limb-sparing surgery around the pelvis and hip (see Chapter 10), hindquarter amputation (hemipelvectomy) often remains the optimal surgical treatment for primary tumors of the upper thigh, hip, or pelvis. Hemipelvectomy may also be life-saving for patients with massive pelvic trauma or uncontrollable sepsis of the lower extremity, and it can provide significant palliation of uncontrollable metastatic lesions of the extremity.1–3 An intimate knowledge of the pelvic anatomy (Figures 20.1A,B) and a systematic approach to the surgical procedure are required to minimize the intraoperative and postoperative morbidity associated with this demanding procedure.The patient is placed in a modified semi-supine position. Incision of the abdominal wall and retroperitoneal dissection of the iliac vessels are performed first. The common iliac, external iliac, or internal iliac (hypogastric) vessels are selectively ligated according to the type of hemipelvectomy to be performed. Exposure of the pubis, bladder neck, and urethra permits sectioning of the symphysis pubis. The iliac wing, sacroiliac joint, or sacrum is then exposed and divided to complete the amputation. Division of the lumbosacral plexus at the level of the sacrum or pelvis is accomplished at the same time. A fasciocutaneous or a myocutaneous flap (involving the gluteus maximus for posterior flaps or the anterior compartment of the thigh for anterior flaps) is then completed. Flexion and adduction/abduction of the hip then allows the surgeon to divide the muscles and ligaments of the pelvic floor and complete the amputation. The wound is closed by rotating and suturing the prepared myocutaneous flap to the abdominal wall and flank. Maximizing the patient’s functional outcome requires the combined skills of an experienced multidisciplinary team of physical, occupational, and rehabilitative therapists." @default.
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- W148621666 date "2006-02-24" @default.
- W148621666 modified "2023-09-26" @default.
- W148621666 title "Posterior Flap Hemipelvectomy" @default.
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- W148621666 doi "https://doi.org/10.1007/0-306-48407-2_20" @default.
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