Hemipelvic amputation

1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Treatment of diseases: sepsis, gas gangrene Indication 1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Preoperative preparation 1. Preoperative oral antibiotics were prepared for the intestines on the 3rd, and the enema was cleaned the night before surgery. 2. Indwelling catheter on the day of surgery. 3. After entering the operating room, suture the anus with a purse-string suture method before the skin is disinfected; paste the penis and scrotum with the tape to the contralateral lower abdomen. 4. Blood with 800 ~ 1000ml during surgery. Surgical procedure 1. Position: half-side supine position. 2. Incision: Because the incision is large, in order to reduce bleeding, it is divided into 3 times. 1 front side incision. From the middle of the iliac crest to the anterior medial aspect of the anterior superior iliac spine, the ligament of the inguinal region was cut to the pubic symphysis. 2 inside incision. From the pubic nodules, the pubic symphysis and the ischial branch are cut back to the ischial tuberosity. 3 posterior incision. From the beginning of the anterior incision in the middle of the iliac crest, the anterior inferior iliac crest is turned back to the posterior superior iliac spine, and the outer side is turned into a large arc to reach the greater trochanter. 3. Cut the anterior tissue: cut along the anterior incision, and cut the intra-abdominal, external oblique and transverse muscles and inguinal ligament from the anterior and superior iliac spines. The posterior retroperitoneal space was separated by a gauze ball to reveal the axilla. The inguinal ligament and the rectus abdominis were cut in the inner part of the pubis, and the spermatic cord was separated to the medial side. The retzius gap is then separated and the bladder is pulled inwardly and downwardly to protect. At this time, the external iliac artery, vein and femoral nerve can be seen in front of the psoas muscle, and cut off according to the conventional treatment. The front side of the wound is filled with a gauze pad. 4. Cut the medial tissue: Cut the medial design incision, and the assistant abducts the hip joint to enlarge the medial field. The pubic and ischial periosteum were dissected and subperiosteal separation was performed. At the same time, the ischial corpus cavernosum and the perineal transverse muscle were separated, the posterior side of the pubic symphysis was separated, the posterior urethra was protected, and the pubic symphysis was cut with a bone knife. 5. Cut the posterior tissue: Move the lower limb to make the hip flexed and retract, cut the posterior incision, reveal the posterior and lower margins of the gluteus maximus, cut the aponeurosis, and then separate the deep gluteal muscle to form the cutaneous muscle flap. Open inward, you can reveal the gluteus medius, short-spinning muscle group and sciatic nerve, hip upper, lower movement, vein, transverse rupture muscle, routine treatment, cut off nerves and blood vessels. Cut the latissimus dorsi and the lumbar muscles at the posterior part of the ankle. The wire saw bypasses the sputum and enters the pelvic cavity to pass through the sciatic incision. After cutting the humerus in front of the ankle joint, cutting the sacrospinous ligament and the sacral ligament, the external pelvis reveals the pelvic contents. Routinely cut off the obturator artery and nerve, cut the psoas muscle in the plane of the ankle joint, and then cut off the starting point of the levator ani muscle from the inner surface of the pubic bone, and the half pelvis and its lower limbs can be broken off. 6. Stitching: completely stop bleeding, flush the wound, and put the hose under negative pressure drainage. The rectus abdominis, the intra-abdominal, the external oblique, the lumbar muscles, and the psoas muscle are then sutured on the gluteus maximus. The flap was sutured by layer.

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