Pelvic

What is meant by Hemicorporectomy?

In medicine (surgery), hemicorporectomy can also be called as translumbar amputation and “halfectomy”.

- It is a radical surgery in which the body below the waist is amputated that transects the lumbar spine.
- Hemi is generally used to refer to one of two sides like e.g., hemiplegia, which affects the arm and leg on one side of the body.
- The first hemicorporectomy was attempted by Charles S. Kennedy in 1960.

This includes the removal of:
- legs,
- the genitalia (internal and external),
- urinary system,
- pelvic bones,
- anus,
- rectum.

What kind of patients is recommended to undergo this procedure?
- It is a severely mutilating procedure recommended only as a last resort for patients.
- It is suggested to the patients with severe and potentially fatal illnesses like osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis.
- Cancer patients who need:
1. Extended radical mastectomy.
2. Radical gastrectomy.
3. Pancreatectomy.
4. Pelvic exenteration.
5. The ‘Commando Operation’ (tongue, jaw and neck dissection).
6. Bilateral back dissection.
7. Hemipelvectomy.
8. Hemicorporectomy or translumbar amputation.

Indications
- The operation is most often performed to treat spreading cancers related to that of the spinal cord and pelvic bones.
- Trauma affecting the pelvic girdle (“open-book fracture”).
- Uncontrollable abscess or ulcers of the pelvic region (causing sepsis).
- Other locally uncontainable conditions.

The Surgical Procedure
- It is often done in two stages.
- It is also possible to conduct the surgery in one stage.
- The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit (bladder).
- The second stage is the amputation.

What are the points to be considered when undergoing this procedure?
- With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored.
- A new blood pressure set-point develops.
- Removal of large parts of the colon can lead to loss of electrolytes.
- A calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney.

Post Treatment
- Extensive physiotherapy and occupational therapy are necessary.
- The design and construction of bucket prosthesis.

Prosthetic
- Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket.
- Early bucket designs often presented significant pressure problems for patients.
- New devices have incorporated with an inflatable rubber lining composed of air pockets.
- These evenly distribute 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.

Postoperative management requires
- Particular attention to fluid replacement,
- Temperature control,
- Pulmonary care.

Long-term management issues involve:
- Hypertension,
- Weight gain,
- Temperature control,
- Stoma management,
- Skin care

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Preventing pelvis or hip joint from brittleness…

Osteoporosis occurs when disintegration of bone cells takes place more quickly than the formation of new ones. This bone loss does not lead to any symptoms for a long time, and is only noticed when some kind of fracture happens. The pelvic girdle forms a stable base where the upper and lower body meet and the most powerful muscle groups and the strongest bones are located.

- Bone substance is built and destroyed during lifetime. Two-third of our bones are composed of mineral salts, calcium being most important. It is integrated in the bone tissue with the help of Vitamin D which is obtained through sunlight and some foods. Bone mass constantly increases until the age of 35. Later, it reduces by about 1.5 percent per year. Bone substance is disintegrated when parathyroid hormone prompts the osteoclasts to remove calcium from bones and release it in blood. Oestrogen in women and testosterone in men play an important role in the metabolism of bones.
- Hormone deficiencies, diet, hyperthyroidism, lack of exercise, and taking medication containing cortisone over a long period of time can harm the bones.
- Bone densitometry is done to diagnose osteoporosis. The radiologist determines the mineral content in the thigh bone or lumbar spine in grams per cubic centimeter. The treatment is primarily with calcium and vitamin D tablets and the administration of calcitonin and sodium fluoride. Earlier, hormone replacement therapy for oestrogen was recommended for women during menopause but recently this method was not in practice as it increases the risk of breast cancer.
- Strategies for preventing osteoporosis include plenty of sunshine and fresh air to boost body’s vitamin D and avoiding alcohol, nicotine and caffeine to prevent calcium depletion.
- A balanced diet rich in calcium and muscle training are recommended.