According to a landmark case review by Jeffrey E. Janis, MD, associate professor and program director in the department of plastic surgery at University of Texas Southwestern Medical Center, and several of his colleagues, hemicorporectomy, or translumbar amputation, should be offered as an option for appropriate patients suffering from terminal pelvic osteomyelitis.
Used as a last-ditch effort to save lives, lower-body amputation is just that — amputating the lower half of a person’s body — and it can improve the quality of life for patients with the proper indications.
Indications for hemicorporectomy include severe trauma and terminal pelvic osteomyelitis, where the patient’s entire pelvis is filled with bone infection that is resistant to typical treatments and mild surgical debridement. During the procedure, a surgeon separates the upper half of the body from the lower half, diverts the fecal and urinary streams, transects the aorta and the spinal cord, and resurfaces the lower half of the torso with tissue derived from the thigh. Although it may seem extreme, it can be a successful treatment when performed on an appropriate candidate, Janis told O&P Business News.
Prosthetic intervention for hemicorporectomy patients is available in the form of a prosthetic bucket, which helps decrease chances of the skin flap reopening and protects the soft tissues of the torso from breakdown. The prosthesis also allows these patients to sit upright, so that they can use their upper bodies to move about.
As necessary as this type of prosthesis might be to protect patients, it is not without its drawbacks. In fact, Janis said that many patients find them to be somewhat cumbersome and discard them upon leaving the hospital.
As the primary teaching hospital for the UT Southwestern Medical Center, Parkland Health and Hospital System in Dallas, where Janis serves as the chief of plastic surgery, is a level one trauma center that employs a multidisciplinary approach to patient care. For procedures as rare and tricky as hemicorporectomy, the plastic surgery team relies on experts in general surgery, psychiatry, urology, neurosurgery, nutrition and pulmonology.
According to the study, only 66 cases of translumbar amputations have been recorded in medical literature worldwide, including nine patients treated at UT Southwestern.
To better prepare themselves to care for these rare patients, study authors reviewed the medical records of those nine hemicorporectomy patients and conducted follow-up interviews on the patients who were still living over a 25-year period to determine their quality of life after the surgery.
The authors concluded that the most important lesson about this type of surgery is that institutions must employ the multidisciplinary approach when treating these patients. The condition is extremely complicated and requires constant conversation among physicians, surgeons and other patient caretakers in order to be successful. In addition, the authors found that there are several technical modifications that decrease blood loss and complication rates in patients, which have not been shared previously. Janis said he hopes that this new study increases awareness of this option and encourages other institutions to modify their techniques to achieve the same positive results.
“[This review] talks about, in an honest way, what complications and what successes we’ve had and what modifications we have made to the original description of this operation so as to make it a safer operation for the patients,” Janis said. — Stephanie Z. Pavlou, ELS
For more information:
- Janis JE, Ahmad J, Lemmon JA, Barnett CC Jr, Morrill KC, McClelland RN. A 25-year experience with hemicorporectomy for terminal pelvic osteomyelitis. Plastic and Reconstructive Surgery. 2009; 124(4):1165-1176.
A hemicorporectomy or translumbar prosthesis is going to be an extremely involved type of prosthesis, both biomechanically and creatively. Providing the correct hydrostatics protection and containment are the keys to success for this type of patient. If these devices are improperly fit, they can frequently create many issues, which will affect postural positioning and the psychological and physiological outcome of the patient.
A properly fitted prosthesis will prevent the patient from completely sitting on their internal organs, helping to avoid further complications. This will make a huge functional impact on their life, how they digest food, how they transfer, how they maintain stability and how they can see people face-to-face. Without a properly fitted prosthetic solution, many of these patients will struggle to survive.
Most practitioners will never have the opportunity to treat this type of patient in their career. The role that we play is crucial in providing functional stability and protection, assisting with an improved functional outcome, and backing up the physicians so that this can be a solution, not a choice.
Once a good prosthetic fit is achieved, more options become immediately available. After stability is in place and control is achieved, the patient can start taking advantage of additional opportunities and you can ask, “Does this patient want to stand and walk?” It definitely can be done. In my clinic, we believe that all patients should be able to live life without limitations.
— Erik Schaffer, CP
President, A Step Ahead Prosthetics & Orthotics