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
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