Hemipelvectomy
Template:Short description Template:Infobox medical intervention
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.<ref name=":0">Template:Cite journal</ref><ref name=":1">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Hemipelvectomy can be further classified as internal and external hemipelvectomy.<ref name=":0" /><ref name=":1" /> An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb.<ref name=":0" /><ref name=":1" /> An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb.<ref name=":0" /><ref name=":1" />
Medical usesEdit
Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms.<ref name=":0" /><ref name=":1" /> Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma.<ref name=":0" /> Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis.<ref name=":0" /> Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, where loss of function of the lower extremity is anticipated.<ref name=":0" /> Internal hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity.<ref name=":0" /> If external hemipelvectomy cannot provide a greater degree of tumor resection compared to internal hemipelvectomy, internal hemipelvectomy is recommended.<ref name=":0" /> Internal hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region.<ref name=":0" />
ComplicationsEdit
As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia.
Complications of external hemipelvectomy include:<ref name=":0" /><ref name=":1" />
- Disfigurement
- Loss of ambulation
- Phantom limb pain
- Bladder dysfunction
- Sexual dysfunction
- Bowel dysfunction
Complications of internal hemipelvectomy include:<ref name=":0" /><ref name=":1" />
- Leg-length discrepancy
- 'Flail hip' or 'floating hip' (referring to hypermobility of the hip joint)
- Hip instability
TechniqueEdit
Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor.<ref name=":0" /> 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.<ref name=":0" /> Surgical oncology techniques are utilized when resecting tumors of the pelvis.<ref name=":0" /> Such techniques ensure that adequate resection margins are obtained at the time of surgery to minimize tumor recurrence.<ref name=":0" />
The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections.<ref name=":0" /><ref name=":22">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=":32">Template:Cite journal</ref> This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III.<ref name=":0" /><ref name=":22" /><ref name=":32" /> Type I resections involve removal of the ilium.<ref name=":0" /><ref name=":22" /><ref name=":32" /> Type II resections involve removal of the peri-acetabular region.<ref name=":0" /><ref name=":22" /><ref name=":32" /> Type III resections involve removal of the ischial and/or pubic region.<ref name=":0" /><ref name=":22" />
Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in internal hemipelvectomy.<ref name=":0" /> Examples of pelvic reconstruction include the use of an allograft, autograft, or prosthesis to bridge the remaining ends of pelvic bone following resection.<ref name=":0" /><ref name=":32" /> 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.<ref name=":0" /><ref name=":32" />
ImagesEdit
- Internal Hemipelvectomy.jpg
An x-ray of a limb-sparing hemipelvectomy on the left side of a male pelvis taken one month after surgery.
- Hemipelvectomy Male Pelvis.jpeg
An x-ray of the same pelvis taken eighteen months after surgery highlighting the femur migration to its final resting place.