- Hemicorporectomy
In
medicine (surgery ), hemicorporectomy (also named translumbar amputation and "halfectomy") is aradical surgery in which the body caudal to thewaist is amputated, transecting thelumbar spine . This removes theleg s, thegenitalia (internal and external),urinary system , pelvic bones,anus , andrectum .cite journal|first=Bernard E.|last=Ferrara|year=1990|month=December|title=Hemicorporectomy: A Collective Review|journal=Journal of Surgical Oncology|volume=45|issue=4|pages=270–278|pmid=2250478|doi=10.1002/jso.2930450412] cite journal|first=Richard K.|last=Shields|coauthors=Dudley-Javoroski, Shauna|year=2003|month=March|title=Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury|journal=Physical Therapy|volume=83|issue=3|pages=263–275|pmid=12620090|url=http://www.ptjournal.org/PTJournal/Mar2003/v83n3p263.cfm] It is a severely mutilating procedure recommended only as alast resort for patients with severe and potentially fatal illnesses such asosteomyelitis ,tumor s, severe traumas and intractabledecubiti in, or around, thepelvis .cite journal|first=Tracy L.|last=Porter-Romatowski|coauthors=Deckert, M. M. Johanna|year=1998|month=April|title=Hemicorporectomy: a case study from a physical therapy perspective|journal=Archives of Physical Medicine and Rehabilitation|volume=79|issue=4|pages=464–468|pmid=9552117|doi=10.1016/S0003-9993(98)90152-6] It has only been reported a few dozen times in medical literature. [http://homepages.iol.ie/~rcsiorth/journal/volume2/june/hemicorp.htm]The nomenclature is somewhat at odds with generally accepted anatomical terms, as "hemi" is generally used to refer to one of two sides (e.g.
hemiplegia , which affects the arm and leg on one side of the body). In that sense, "paracorporectomy" might more closely reflect the nature of the procedure.History
The development of surgical medicine was vastly accelerated during, and following, the
Second World War . Rarely experienced traumas were made more common by new weaponry. This required decisive surgical action as well as the development of new techniques. As B. E. Ferrara stated in his summative article on hemicorporectomy:lessons learned from battle field injuries quickened innovative treatment of congenital and acquired conditions... [the general surgeon] devised extensive cancer operations including extended radical mastectomy, radical gastrectomy and pacreatectomy, pelvic exenteration, the 'Commando operation' (tongue, jaw and neck dissection), bilateral back dissection, hemipelvectomy, and then hemicorporectomy or translumbar amputation, referred to as the most revolutionary of all operative procedures.
It was into this environment that Frederick E. Kredel first proposed the operation in February
1951 while discussing a paper on pelvic exenteration. The first hemicorporectomy was attempted by Charles S. Kennedy in1960 , but the patient died eleven days later.J. Bradley Aust and Karel B. Absolon conducted the first successful hemicorporectomy inMinnesota in1961 .Indications
The operation most often results after spreading cancers of the spinal cord and pelvic bones. Other reasons may include trauma affecting the pelvic girdle ("open-book fracture"), uncontrollable
abscess orulcer s of the pelvic region (causingsepsis ) or other locally uncontainable conditions. It is used in cases wherein evenpelvic exenteration would not remove sufficient tissue.Procedure
The surgical procedure is often done in two stages; however it is possible to conduct the surgery in one stage. The first stage is the discontinuation of the waste functions in
colostomy (rectum) andileal conduit (bladder). The second stage is the amputation.Considerations
With the removal of almost half of the circulatory system,
cardiac function needs to be closely monitored while a newblood pressure set-point develops.Removal of large parts of the colon can lead to loss of
electrolyte s. Similarly, calculated measurements ofrenal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of thekidney , as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient.Revalidation
Extensive
physiotherapy andoccupational therapy are necessary for a patient to return to some form of normal life, which invariably involves using awheelchair . Designing aprosthesis for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly).Traumatic hemicorporectomy
Many
emergency room s have protocols under which they will not resuscitate or support a patient who has already undergone a severe bisection injury that is essentially a "de facto " hemicorporectomy. This stance is largely due to very limited rates of survival. A study which cased 267 blunt and penetrating trauma patients (decapitation , hemicorporectomy, etc.) who had cardiopulmonary arrest found that only 7 survived long term, only four of whom returned to their previous neurologic level.cite journal|first=S.|last=Shimazu|coauthors=Shatney, C. H.|year=1983|month=March|title=Outcomes of trauma patients with no vital signs on hospital admission|journal=Journal of Trauma|volume=23|issue=3|pages=213–216|pmid=6834443] Apart from the overwhelming statistical unlikelihood of survival, operative hemicorporectomy is unlikely to be successful unless the patient has the "sufficient emotional and psychological maturity to cope" and "sufficient determination and physical strength to undergo the intensive rehabilitation".cite journal|first=J. J.|last=Terz|coauthors=Schaffner, M. J., Goodkin, R., Beatty, J. D., Razor, B., Weliky, A., Shimabukuro, C.|year=1990|month=June|title=Translumbar amputation|journal=Cancer|volume=65|issue=12|pages=2668–2675|pmid=2340466|doi=10.1002/1097-0142(19900615)65:12<2668::AID-CNCR2820651212>3.0.CO;2-I]Emergency rooms and ambulance services often release policy which prevents the resuscitation of such patients. The UK's
National Health Service , for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy as "unequivocally associated with death" and that such injuries should be considered "incompatible with life".cite book|author=Avon Ambulance Service NHS Trust|title=Policy and procedures for the recognition of life extinct| url=http://www.avonamb.nhs.uk/NR/rdonlyres/6E805679-6C19-46D0-8689-7BE699EAEB93/0/MD216Jan2005.pdf| chapter=3. Conditions unequivocally associated with death|pages=6|month=January|year=2005|id=MD216] TheNational Association of EMS Physicians (NAEMSP) and theAmerican College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine such patients unresuscitatable.cite journal|first=L. R.|last=Hopson|coauthors=Hirsh, E., Delgado, J., Domeier, R. M., McSwain, N. E., Krohmer, J.; National Association of EMS Physicians; American College of Surgeons Committee on Trauma|year=2003|month=January|title=Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma|journal=Journal of the American College of Surgeons|volume=196|issue=1|pages=106–112|pmid=12517561|doi=10.1016/S1072-7515(02)01668-X]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, however new devices have incorporated an inflatable rubber lining composed of air pockets that evenly distributes pressure based on the patient's motions. Two openings at the front of the bucket create space for the
colostomy bag and theileal conduit .ee also
*
Amputation
*Sawing a woman in half - Magic trick
*"The Godwhale ", a science fiction novel featuring a protagonist who has undergone this procedureReferences
External links
* [http://www.pandocare.com/pdf/P&OJonWilsonROHOAbstract.pdf A new concept in prosthetic interface design]
* [http://www.straitstimes.com/Free/Story/STIStory_137731.html Mr Amri Mohd Samat] - a 41 year old who has had the surgery after a devastating infection. Photo included.
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