Hemicorporectomy

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Hemicorporectomy
Pronunciation /ˌhɛmiˌkɔːrpəˈrɛktəmi/
Other namesTranslumbar amputation, corporal transection, hemisomato-tmesis, halfectomy
ICD-10-PCS S38.3
MeSH D006428

Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia (internal and external), urinary system, pelvic bones, anus, and rectum. [1] [2] It is a major procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis. [3] By 2009, 66 cases had been reported in medical literature. [4]

Contents

Medical uses

The operation is performed to treat spreading cancers of the spinal cord and pelvic bones. Other reasons may include trauma affecting the pelvic girdle ("open-book fracture"), uncontrollable abscess or ulcers of the pelvic region (causing sepsis) or other locally uncontainable conditions. [2] It is used in cases wherein even pelvic exenteration would not remove sufficient tissue.[ citation needed ]

Procedure

The surgical procedure is typically done in two stages, but it is possible to conduct the surgery in one stage. The first stage is the discontinuation of the waste functions by performing a colostomy and ileal conduit in the upper abdominal quadrants. The second stage is the amputation at the lumbar spine. [5] [6]

Considerations

With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored while a new blood pressure set-point develops.[ citation needed ]

Removal of large parts of the colon can lead to loss of electrolytes. Similarly, calculated measurements of renal function (such as the Cockcroft-Gault formula) are unlikely to reflect actual activity of the kidney, as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient.[ citation needed ]

Rehabilitation

Extensive physiotherapy and occupational therapy are necessary after the procedure. A return to mobility will generally involves the use of a wheelchair and potentially a prosthetic. Designing a prosthesis for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly).

Traumatic hemicorporectomy

Individuals sustaining a severe bisection injury that is essentially a de facto hemicorporectomy rarely reach a hospital before dying. Apart from the very low likelihood of surviving such an injury, even an operative hemicorporectomy is unlikely to be successful unless the patient has "sufficient emotional and psychological maturity to cope" and "sufficient determination and physical strength to undergo the intensive rehabilitation". [7]

Emergency rooms and ambulance service policies advise against the resuscitation of such patients. The UK's National Health Service, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy (along with decapitation) as "unequivocally associated with death" and that such injuries should be considered "incompatible with life" in patients under 18. [8] The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine if patients are to be considered unresuscitatable. [9]

In one case documented by the Archives of Emergency Medicine in 1989, a woman who sustained a complete corporal transection (hemicorporectomy) after being struck by a train arrived at a hospital in a "fully conscious" state and "was aware of the nature of her injury and wished for further treatment." Although the patient was initially stabilized and underwent three hours of emergency surgery, she died approximately two hours later due to "hypovolemia, cardiac arrhythmia and biochemical imbalance." [10]

Prosthesis

Following a hemicorporectomy, patients are fitted with a socket-type prosthesis often referred to as a bucket. Early bucket designs often presented significant pressure problems for patients, but new devices have incorporated an inflatable rubber lining composed of air pockets that evenly distributes pressure based on the patient's motions. Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.[ citation needed ]

History

The development of surgical medicine was vastly accelerated during, and following, the Second World War. Rarely-experienced traumas were made more common by new weaponry. This required decisive surgical action as well as the development of new techniques. As B. E. Ferrara stated in his summative article on hemicorporectomy,

Lessons learned from battle field injuries quickened innovative treatment of congenital and acquired conditions ... [the general surgeon] devised extensive cancer operations including extended radical mastectomy, radical gastrectomy and pancreatectomy, pelvic exenteration, the 'Commando Operation' (tongue, jaw and neck dissection), bilateral back dissection, hemipelvectomy, and then hemicorporectomy or translumbar amputation, referred to as the most revolutionary of all operative procedures. [1]

It was into this environment that Frederick E. Kredel first proposed the operation in February 1951 while discussing a paper on pelvic exenteration. [1]

List of people with hemicorporectomy

See also

Related Research Articles

<span class="mw-page-title-main">Amputation</span> Medical procedure that removes a part of the body

Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventive surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used to punish people who commit crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator. The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, East Kalimantan, Indonesian Borneo dating back to at least 31,000 years ago, where it was done when the amputee was a young child.

<span class="mw-page-title-main">Urology</span> Medical specialty

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

<span class="mw-page-title-main">Surgery</span> Medical procedures that involve incisive or invasive instruments into body cavities

Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or improve aesthetics and appearance, or to remove unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Bone tumor</span> Medical condition

A bone tumor is an abnormal growth of tissue in bone, traditionally classified as noncancerous (benign) or cancerous (malignant). Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung, breast, thyroid, kidney and prostate. There may be a lump, pain, or neurological signs from pressure. A bone tumor might present with a pathologic fracture. Other symptoms may include fatigue, fever, weight loss, anemia and nausea. Sometimes there are no symptoms and the tumour is found when investigating another problem.

<span class="mw-page-title-main">Battlefield medicine</span> Treatment of wounded combatants and non-combatants in or near an area of combat

Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Minimally invasive procedure</span> Surgical technique that limits size of surgical incisions needed

Minimally invasive procedures encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiring incisions of some size are referred to as open surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery.

<span class="mw-page-title-main">Hemipelvectomy</span> Surgical removal of half of the pelvis

Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. Hemipelvectomy can be further classified as internal and external hemipelvectomy. An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb.

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In medicine, the ileal pouch–anal anastomosis (IPAA), also known as restorative proctocolectomy (RPC), ileal-anal reservoir (IAR), an ileo-anal pouch, ileal-anal pullthrough, or sometimes referred to as a J-pouch, S-pouch, W-pouch, or a pelvic pouch, is an anastomosis of a reservoir pouch made from ileum to the anus, bypassing the former site of the colon in cases where the colon and rectum have been removed. The pouch retains and restores functionality of the anus, with stools passed under voluntary control of the person, preventing fecal incontinence and serving as an alternative to a total proctocolectomy with ileostomy.

<span class="mw-page-title-main">Pelvic exenteration</span> Surgical removal of all pelvic organs

Pelvic exenteration is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are removed. In women, the vagina, cervix, uterus, Fallopian tubes, ovaries and, in some cases, the vulva are removed. In men, the prostate is removed. The procedure leaves the person with a permanent colostomy and urinary diversion.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.

<span class="mw-page-title-main">Blunt trauma</span> Trauma to the body without penetration of the skin

Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, sports-related injuries, and are notably common among the elderly who experience falls.

Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.

An exploratory laparotomy is a general surgical operation where the abdomen is opened and the abdominal organs are examined for injury or disease. It is the standard of care in various blunt and penetrating trauma situations in which there may be life-threatening internal injuries. It is also used in certain diagnostic situations, in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of disease, and in the staging of some cancers.

Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.

In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups.

<span class="mw-page-title-main">Resuscitative thoracotomy</span> Type of thoracotomy

A resuscitative thoracotomy (sometimes referred to as an emergency department thoracotomy (EDT), trauma thoracotomy or, colloquially, as "cracking the chest") is a thoracotomy performed to aid in the resuscitation of a major trauma patient who has sustained severe thoracic or abdominal trauma. The procedure allows immediate direct access to the thoracic cavity, permitting rescuers to control hemorrhage, relieve cardiac tamponade, repair or control major injuries to the heart, lungs or thoracic vasculature, and perform direct cardiac massage or defibrillation. The procedure is rarely performed and is a procedure of last resort.

<span class="mw-page-title-main">Resuscitative endovascular balloon occlusion of the aorta</span> Temporary procedure to support blood pressure and stem blood loss

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure performed during resuscitation of critically injured trauma patients. Originally developed as a less invasive alternative to emergency thoracotomy with aortic cross clamping, REBOA is performed to gain rapid control of non-compressible truncal or junctional hemorrhage. REBOA is performed first by achieving access to the common femoral artery (CFA) and advancing a catheter within the aorta. Upon successful catheter placement, an occluding balloon may be inflated either within the descending thoracic aorta or infrarenal abdominal aorta. REBOA stanches downstream hemorrhage and improves cardiac index, cerebral perfusion, and coronary perfusion. Although REBOA does not eliminate the need for definitive hemorrhage control, it may serve as a temporizing measure during initial resuscitation. Despite the benefits of REBOA, there are significant local and systemic ischemic risks. Establishing standardized REBOA procedural indications and mitigating the risk of ischemic injury are topics of ongoing investigation. Although this technique has been successfully deployed in adult patients, it has not yet been studied in children.

References

  1. 1 2 3 Ferrara, Bernard E. (December 1990). "Hemicorporectomy: A Collective Review". Journal of Surgical Oncology. 45 (4): 270–278. doi:10.1002/jso.2930450412. PMID   2250478. S2CID   35307193.
  2. 1 2 Shields, Richard K.; Dudley-Javoroski, Shauna (March 2003). "Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury". Physical Therapy. 83 (3): 263–275. doi:10.1093/ptj/83.3.263. PMC   4042312 . PMID   12620090. Archived from the original on June 27, 2004.
  3. ↑ Porter-Romatowski, Tracy L.; Deckert, M. M. Johanna (April 1998). "Hemicorporectomy: a case study from a physical therapy perspective". Archives of Physical Medicine and Rehabilitation. 79 (4): 464–468. doi:10.1016/S0003-9993(98)90152-6. PMID   9552117.
  4. ↑ Janis, Jeffrey E; Ahmad, Jamil; Lemmon, Joshua A; Barnett Jr, Carlton C; Morrill, Kevin C; McClelland, Robert N (October 2009). "A 25-year experience with hemicorporectomy for terminal pelvic osteomyelitis". Plastic and Reconstructive Surgery. 124 (4): 1165–76. doi:10.1097/PRS.0b013e3181b61169. PMID   19935300. S2CID   19312510.
  5. ↑ Weaver, Jane; Flynn, Michael (Feb 2000). "Hemicorporectomy". Journal of Surgical Oncology. 73 (2): 117–24. doi:10.1002/(SICI)1096-9098(200002)73:2<117::AID-JSO12>3.0.CO;2-C. PMID   10694650.
  6. ↑ Aust, JB; Page, CP (Dec 1985). "Hemicorporectomy". Journal of Surgical Oncology. 30 (4): 226–30. doi:10.1002/jso.2930300408. PMID   4079439. S2CID   221890435.
  7. ↑ Terz, J. J.; Schaffner, M. J.; Goodkin, R.; Beatty, J. D.; Razor, B.; Weliky, A.; Shimabukuro, C. (June 1990). "Translumbar amputation". Cancer. 65 (12): 2668–2675. doi: 10.1002/1097-0142(19900615)65:12<2668::AID-CNCR2820651212>3.0.CO;2-I . PMID   2340466.
  8. ↑ Sherwood, Dave; Deakin, Charles (2020). Resuscitation Policy and Recognition of Life Extinct (PDF) (7th ed.). Oxfordshire, England: South Central Ambulance Service NHS Foundation Trust. pp. 16, 46. Archived (PDF) from the original on 2023-05-10. Retrieved 21 April 2022.
  9. ↑ Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE, Krohmer J (January 2003). "Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma". Journal of the American College of Surgeons. 196 (1): 106–112. doi:10.1016/S1072-7515(02)01668-X. PMID   12517561.
  10. ↑ Walker SJ, Johnson RH (1989). "Traumatic hemisomato-tmesis: a case report and review of the literature". Arch Emerg Med. 6 (1): 66–9. doi:10.1136/emj.6.1.66. PMC   1285562 . PMID   2653349.
  11. ↑ "Great Falls teen, amputated from the waist down, inspires millions". KRTV. 2020-11-26. Retrieved 2022-07-12.
  12. ↑ Loren’s Accident (previously titled: "Loren's Story: Viral TikTok Story Time") , retrieved 2022-07-12
  13. ↑ "Sabia and Loren - YouTube". www.youtube.com. Retrieved 2022-07-12.
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