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Indications for amputation in patients with arterio-venous malformations
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
In the past, extensive surgical removal of AVMS, such as hip disarticulation or hemipelvectomy1 under cardiopulmonary bypass2 or deep hypothermic circulatory arrest,3, 4 has been reported for the purpose of complete removal of the AVM lesions. In current practice, such extensive surgery is rarely performed. When surgical removal of AVMs is required, a strategy of preoperative endovascular embolization and later surgical removal of AVM is more often used instead of extensive surgery. When residual or recurrent AVMs developed after limb amputation, staged endovascular therapy can be performed.
Methods for assigning impairment
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Korea’s Guideline Rating the Physical Impairment assigns the lower extremity impairment for amputations of the lower extremity. It describes 110% for hemipelvectomy, 100% for hip disarticulation, 100% for above knee amputation proximal, 90% for above knee amputation mid-thigh, and 80% for above knee amputation distal amputation. It assigns 80% to knee disarticulation and below knee amputation shorter than 8 cm, and 70% for below knee amputation ≥8 cm (81).
Skin Flap Physiology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Colin MacIver, Stergios Doumas
Recently, there have been attempts to revascularize severed limbs or free flaps in vessel-depleted necks both in animal models and humans via extracorporeal perfusion (ECP). This technique refers to a pump-assisted perfusion of the tissues in order to obviate the deleterious effects of prolonged ischaemia. In 2005, Newsome et al. presented a case report of a boy with chondroblastic osteosarcoma of the right hemipelvis with involvement of the common, internal, and external iliac vessles on the right side. The patient underwent hemipelvectomy and high above-knee amputation of the ipsilateral leg. The amputated extremity was placed on extracorporeal bypass using an extracorporeal machine oxygenation (ECMO) circuit connected to the femoral vessels for 162 min. at 32°C. While maintaining extracorporeal circulation, an anterior thigh free flap was created and later used for soft-tissue reconstruction.
The importance of the rehabilitation program following an internal hemipelvectomy and reconstruction with limb salvage – gait analysis and outcomes: a case study
Published in Disability and Rehabilitation, 2019
The extent of the surgery is dependent on tumor location, size and margins and invasiveness with involvement of vital neurovascular structures [7]. Internal hemipelvectomy is now considered the surgical procedure of choice for local control of malignant bone tumors in more than 90% of patients [8]. It is a surgical procedure of partial to complete unilateral resection of bone and soft tissue of the pelvis with preservation of the ipsilateral leg. It is indicated when tumor resection with wide margins can be obtained without sacrificing the remaining neurovascular tissue [9].