Hip Disarticulation / Boyd Technique
Anterior Racquet shaped incision
- begins just inferior to ASIS
- curves medially to under inguinal ligament
- 5 cm distal to adductor origin
Identify and ligate femoral artery and vein
Posterior incision
- 5 cm beneath ischial tuberosity
- laterally 8 cm below greater trochanter
- then curve back to ASIS
Superficial Dissection
- detach sartorius & rectus femoris proximal
- divide pectineus 1/2 inch from the pubis
- avoid division of obturator vessels from where exit pelvis
Anterior Deep Dissection
- ER leg
- divide iliopsoas tendon at LT
- detach adductors & gracilis at ischium
- expose and ligate obturator artery / nerve between pectineus & obturator externus at femur
Posterior Deep Dissection
- IR leg
- divide obturator externus / short external rotators at femur
- detach G max & G med from femur
- divide G max in line of skin incision
Hip
- disarticulation
- divide capsule & L Teres
- divide hamstrings at ischium
Muscle flaps
- suture gluteal flap to pectineus & adductor muscles
- approximate skin edges
Hindquarter Amputation
AKA
- hemipelvectomy
- trans-iliac /trans-pelvic amputation
Set Up
- two surgeons
- colostomy & stitch anus closed
- eschmarc to express limb of blood to prevent shock
- cross match 3 L of blood
- prepped from chest to below knees
- tape scrotum to opposite leg
- special frame to hold leg
- lateral with amputated limb up
3 Part Technique King & Steelquist
Anterior Part
- begin incision at pubic tubercle
- extend along inguinal ligament to ASIS
- extend along crest to PSIS
- detach abdominal muscles & inguinal ligament from the crest
- open iliac fossae between peritoneum & iliacus
- at the pubis severe the inguinal ligament & the rectus abdominis & retract the cord medially
- open the space of retzius & retract the bladder into the pelvis
- divide external iliac artery and vein & femoral nerve
Perineal Part
- widely abduct the leg
- extend the incision from the pubic tubercle, along the pubic & ischial rami to the ischial tuberosity
- expose the subcutaneous rami
- elevate the ischiocavernosus & transversus perinei subperiosteally from the rami inferior surfaces
- divide symphysis pubis with osteotome
Posterior Part
- carry incision from PSIS to GT then along gluteal crease to ischial tuberosity
- expose G max aponeurosis in line with the skin incision
- elevate G max, forming a large flap of skin, fat & muscle
- expose G medius & short rotators into view
- sever piriformis & sciatic nerve
- pass gigli saw through greater sciatic notch & bring it out over iliac crest just anterior to SIJ
- divide ilium, sacrotuberous & sacrospinous ligaments
- rotate inominate bone with leg to expose pelvic contents
- divide obturator artery and vein
- divide psoas at SIJ
- divide levator ani off pelvic wall
- hemipelvis now free
Closure
- suture G max flap to rectus abdominus / lateral abdominal wall / quadratus lumborum / psoas
- close skin over drains
- firm dressing