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Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of portion of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. [1] [2] Hemipelvectomy can be further classified as internal and external hemipelvectomy. [1] [2] An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. [1] [2] An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb. [1] [2]
Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms. [1] [2] Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. [1] Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis. [1] Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, where loss of function of the lower extremity is anticipated. [1] Internal hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity. [1] If external hemipelvectomy cannot provide a greater degree of tumor resection compared to internal hemipelvectomy, internal hemipelvectomy is recommended. [1] Internal hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region. [1]
As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia.
Risks of external hemipelvectomy include: [1] [2]
Risks of internal hemipelvectomy include: [1] [2]
Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor. [1] Imaging studies such as conventional radiography, computed tomography, and magnetic resonance imaging help the surgeon visualize the anatomy and its relationship to the local pathology. [1] Surgical oncology techniques are utilized when resecting tumors of the pelvis. [1] Such techniques ensure that adequate resection margins are obtained at the time of surgery to minimize tumor recurrence. [1]
The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections. [1] [3] [4] This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III. [1] [3] [4] Type I resections involve removal of the ilium. [1] [3] [4] Type II resections involve removal of the peri-acetabular region. [1] [3] [4] Type III resections involve removal of the ischial and/or pubic region. [1] [3]
Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in internal hemipelvectomy. [1] Examples of pelvic reconstruction include the use of an allograft, autograft, or prosthesis to bridge the remaining ends of pelvic bone following resection. [1] [4] Arthrodesis is a technique that can be used in internal hemipelvectomy to fix the proximal femur to a segment of pelvic bone for the purposes of stabilizing the lower extremity. [1] [4]
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, such as Afghanistan, Brunei, Iran, Saudi Arabia and the United Arab Emirates, 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.
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.
Orthopedic surgery or orthopedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.
Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia, urinary system, pelvic bones, anus, and rectum. It is an extremely mutilating 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. By 2009, 66 cases have been reported in medical literature. The most recent documented operation was in September 2019.
Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage. A chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas. About 30% of bone sarcomas are chondrosarcomas. It is resistant to chemotherapy and radiotherapy. Unlike other primary bone sarcomas that mainly affect children and adolescents, a chondrosarcoma can present at any age. It more often affects the axial skeleton than the appendicular skeleton.
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as: general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery and pediatric surgery.
External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide stability are positioned entirely within the patient's body. It is used to stabilize bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bony continuity and a functional soft tissue cover.
A malignant peripheral nerve sheath tumor (MPNST) is a form of cancer of the connective tissue surrounding nerves. Given its origin and behavior it is classified as a sarcoma. About half the cases are diagnosed in people with neurofibromatosis; the lifetime risk for an MPNST in patients with neurofibromatosis type 1 is 8–13%. MPNST with rhabdomyoblastomatous component are called malignant triton tumors.
Prostatectomy as a medical term refers to the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.
ICD-9-CM Volume 3 is a system of procedural codes used by health insurers to classify medical procedures for billing purposes. It is a subset of the International Statistical Classification of Diseases and Related Health Problems (ICD) 9-CM. Volumes 1 and 2 are used for diagnostic codes.
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.
Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.
A pelvic fracture is a break of the bony structure of the pelvis. This includes any break of the sacrum, hip bones, or tailbone. Symptoms include pain, particularly with movement. Complications may include internal bleeding, injury to the bladder, or vaginal trauma.
Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur.
The pelvis is the lower part of the trunk, between the abdomen and the thighs, together with its embedded skeleton.
Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to give patients an alternative to amputation. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, alloprosthetic composite, endoprosthetic reconstruction, prosthetic implants, and rotationplasty.
Giant-cell tumor (GCT) of the pelvis is uncommon, accounting for only 1.5 to 6% of cases of GCT. In pelvis ilium is the most common site of involvement; ischium and pubis are less frequently involved. It typically presents in adults between age of 20 to 50 with localized swelling and pain. Females are slightly more affected than males.
The following outline is provided as an overview of and topical guide to trauma and orthopaedics: