The Experts below are selected from a list of 591 Experts worldwide ranked by ideXlab platform
Constantine P. Karakousis - One of the best experts on this subject based on the ideXlab platform.
-
Hemipelvectomy (Hindquarter Amputation)
Atlas of Operative Procedures in Surgical Oncology, 2014Co-Authors: Constantine P. KarakousisAbstract:The term “Hemipelvectomy” implies the removal of the right or left hemipelvis along with the ipsilateral extremity and suggests that the division of the bone was carried through the sacroiliac joint. When part of the posterior portion of the iliac bone is preserved, the procedure is called “conservative Hemipelvectomy.” A conservative Hemipelvectomy suffices for most tumors requiring this amputation. Although Hemipelvectomy has been performed rarely for benign conditions extensively involving the soft tissues and underlying bones at the level of the hip, it is usually performed for malignant tumors located in the proximal thigh near the level of the inguinal ligament or in the iliac fossa, or tumors infiltrating the wall of the lesser pelvis that are so extensive in terms of soft tissue and osseous involvement that they cannot be conservatively removed completely with preservation of the extremity. The abdominoinguinal incision has made Hemipelvectomy unnecessary for most tumors located in the iliac fossa or in the wall of the lesser pelvis. Tumors located in the buttock that are not resectable with a more conservative operation can be managed with this procedure, but an anterior flap is required. The unqualified term “Hemipelvectomy” implies the use of a posterior flap.
-
Blood Supply of Hemipelvectomy Flaps: The Anterior Flap Hemipelvectomy
Archives of surgery (Chicago Ill. : 1960), 2001Co-Authors: Mahmoud N. Kulaylat, Anthony Froix, Constantine P. KarakousisAbstract:In posterior flap Hemipelvectomy, preservation of the gluteus maximus with the flap guarantees its viability regardless of the level of ligation of the iliac vessels. In anterior flap Hemipelvectomy with the quadriceps femoris attached to the flap, the dominant blood supply is through the lateral femoral circumflex branches of the profunda vessels, which is sufficient to maintain the flap.
-
complications and outcome of external Hemipelvectomy in the management of pelvic tumors
Annals of Surgical Oncology, 1996Co-Authors: Justus P Apffelstaedt, Deborah L Driscoll, James E Spellman, Augustine Velez, John F Gibbs, Constantine P. KarakousisAbstract:Background: Although the technique of external Hemipelvectomy has been adequately described, little is known about its complications and late results.
-
various types of Hemipelvectomy for soft tissue sarcomas complications survival and prognostic factors
Surgical Oncology-oxford, 1995Co-Authors: J P Apffelstaedt, D L Driscoll, Paul J Zhang, Constantine P. KarakousisAbstract:Fifty-three hemipelvectomies were performed for primary or recurrent soft tissue sarcomas with fixation to the pelvis or peripelvic tissues. Resection was carried out in the absence of distant metastases in 70% of the cases. The Hemipelvectomy was posterior in 66%, anterior in 6% and internal in 28%. Post-operative complications included wound edge necrosis in 19% and infection in 43% of cases. The mortality rate was 5.7%. Margins were macroscopically clear in 76% and marginal in 24% of cases. Tumours were high grade in 92%; their mean diameter was 16.5 cm. Local recurrence occurred in 19% and distant recurrence in 66% of patients. Overall survival was 39% at 2 years and 10% at 5 years. Pelvic soft tissue sarcomas have a poor prognosis. However, in the absence of other effective therapy, Hemipelvectomy provides local control with acceptable morbidity in the majority of patients, with a small percentage (10%) surviving 5 years or longer.
-
partial and complete internal Hemipelvectomy complications and long term follow up
Journal of The American College of Surgeons, 1995Co-Authors: J P Apffelstaedt, D L Driscoll, Constantine P. KarakousisAbstract:Background The complications and long-term follow-up results of internal Hemipelvectomy are not well documented. Study design We reviewed 32 internal hemipelvectomies performed between 1976 and 1994. Results The pathologic diagnoses were soft tissue sarcoma in 15 cases, bone tumor in 14 cases, melanoma in two cases, and carcinoma in one of the cases. In 24 cases, the intent of surgery was curative; in 22 cases, the procedure was modified. Average blood loss was 3.2 L; the procedure took on average 7.5 hours. Complications included skin flap necrosis in four cases, infection in 15 cases, and various other complications in five cases. Three mortalities (9 percent) occurred. Thirty-four percent of the patients ambulated without any assistance, 59 percent ambulated with crutches, while 7 percent remained wheel-chair bound. The survival rate after resection for cure was 45 percent at ten years compared with 29 percent at two years for palliative resections. Conclusions Internal Hemipelvectomy is a complex procedure that is functionally and cosmetically superior to external Hemipelvectomy and, when done with curative intent, results in considerable long-term survival rates.
Franklin H Sim - One of the best experts on this subject based on the ideXlab platform.
-
functional outcome measures of patients following Hemipelvectomy
Prosthetics and Orthotics International, 2016Co-Authors: Matthew T. Houdek, Michael E Kralovec, Thomas C Shives, Karen L Andrews, Peter S. Rose, Brian R Kotajarvi, Fantley Smither, Franklin H SimAbstract:Background:Major amputations are indicated for curative treatment of some tumors of the pelvis. Previous literature suggests that patients with a Hemipelvectomy amputation are more efficient walking with crutches than using a prosthesis.Objectives:The purpose of this study was to evaluate whether modern prosthetic use after Hemipelvectomy may be a viable option for patients than in the past.Study Design:Case control trial.Methods:We identified five patients who underwent Hemipelvectomy amputation and fit with high-level prosthetic components. Patients were evaluated using a timed up and go, 5-m walk, 400-m walk, and stair climb tests to evaluate functional performance with a prosthesis and without. Short Form–36 scores were collected as well. These results were compared to matched controls.Results:There was a trend for faster locomotion using crutches over wearing a prosthesis in the timed up and go, and 5-m and 400-m walk; no difference was seen in stair climbing. Short Form–36 scores showed decreased ph...
-
survival local recurrence and function after pelvic limb salvage at 23 to 38 years of followup
Clinical Orthopaedics and Related Research, 2012Co-Authors: Courtney E Sherman, Mary I Oconnor, Franklin H SimAbstract:Background Malignant pelvic tumors frequently pose challenges to surgeons owing to complex pelvic anatomy and local extension. External Hemipelvectomy frequently allows adequate margins but is associated with substantial morbidity and reduced function. Limb salvage is an alternative approach when adequate margins can be achieved, but long-term function and survival are unclear.
-
soft tissue reconstruction of external Hemipelvectomy defects
Plastic and Reconstructive Surgery, 2009Co-Authors: Alex Senchenkov, Steven L Moran, Paul M Petty, James Knoetgen, Ricky P Clay, Uldis Bite, Sunni A Barnes, Nho V Tran, Craig H Johnson, Franklin H SimAbstract:Background:External Hemipelvectomy is the ultimate salvage procedure for locally advanced pelvic tumors, infections, and failed revascularizations. It is associated with high wound morbidity requiring surgical management. In this study, the authors analyzed their experience with primary and secondar
-
predictors of complications and outcomes of external Hemipelvectomy wounds account of 160 consecutive cases
Annals of Surgical Oncology, 2008Co-Authors: Alex Senchenkov, Steven L Moran, Paul M Petty, James Knoetgen, Ricky P Clay, Uldis Bite, Sunni A Barnes, Franklin H SimAbstract:Background Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence Hemipelvectomy wound morbidity.
Shimpei Miyamoto - One of the best experts on this subject based on the ideXlab platform.
-
free latissimus dorsi musculocutaneous flap for external Hemipelvectomy reconstruction
Microsurgery, 2019Co-Authors: Kensuke Tashiro, Akira Kawai, Masaki Arikawa, Yutaka Fukunaga, Fumihiko Nakatani, Eisuke Kobayashi, Shimpei MiyamotoAbstract:Introduction External Hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external Hemipelvectomy for recurrent pelvic malignancies. Methods Six patients underwent external Hemipelvectomy and immediate reconstruction using a free LDMC flap between November 2012 and June 2017. The mean age of the patients was 65 years (range: 63-69 years). The primary tumors were myxoid liposarcoma, chondrosarcoma, osteosarcoma, squamous cell carcinoma, and pleomorphic liposarcoma. A free LDMC flap was harvested from the ipsilateral back and transferred to the defect. When an intercostal nerve was found at the recipient site, the thoracodorsal nerve was coaptated with the intercostal nerve to reinnervate the muscle. Results The mean flap size was 23 × 10 cm and the range was 20 × 8-27 × 13.5 cm. The contralateral deep inferior epigastric vessels were used as recipient vessels in all patients. Thoracodorsal-intercostal nerve coaptation was performed in 2 patients. The flap survived in all patients. Three patients had complications of abscess formation. No patient developed postoperative hernia. Conclusion Although it is challenging to do reconstruction after external Hemipelvectomy, a free LDMC flap has several advantages, including a large coverage area, stability of circulation, ease of elevation, and preservation of the strength of the remaining abdominal wall. Technical tips for selecting anastomosis vessels are important and nerve coaptation could be effective.
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:Introduction In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications.
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications. We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal Hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3–131 months). The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3–7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up. In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary.
Akira Kawai - One of the best experts on this subject based on the ideXlab platform.
-
free latissimus dorsi musculocutaneous flap for external Hemipelvectomy reconstruction
Microsurgery, 2019Co-Authors: Kensuke Tashiro, Akira Kawai, Masaki Arikawa, Yutaka Fukunaga, Fumihiko Nakatani, Eisuke Kobayashi, Shimpei MiyamotoAbstract:Introduction External Hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external Hemipelvectomy for recurrent pelvic malignancies. Methods Six patients underwent external Hemipelvectomy and immediate reconstruction using a free LDMC flap between November 2012 and June 2017. The mean age of the patients was 65 years (range: 63-69 years). The primary tumors were myxoid liposarcoma, chondrosarcoma, osteosarcoma, squamous cell carcinoma, and pleomorphic liposarcoma. A free LDMC flap was harvested from the ipsilateral back and transferred to the defect. When an intercostal nerve was found at the recipient site, the thoracodorsal nerve was coaptated with the intercostal nerve to reinnervate the muscle. Results The mean flap size was 23 × 10 cm and the range was 20 × 8-27 × 13.5 cm. The contralateral deep inferior epigastric vessels were used as recipient vessels in all patients. Thoracodorsal-intercostal nerve coaptation was performed in 2 patients. The flap survived in all patients. Three patients had complications of abscess formation. No patient developed postoperative hernia. Conclusion Although it is challenging to do reconstruction after external Hemipelvectomy, a free LDMC flap has several advantages, including a large coverage area, stability of circulation, ease of elevation, and preservation of the strength of the remaining abdominal wall. Technical tips for selecting anastomosis vessels are important and nerve coaptation could be effective.
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:Introduction In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications.
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications. We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal Hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3–131 months). The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3–7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up. In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary.
Koichi Ogura - One of the best experts on this subject based on the ideXlab platform.
-
rate and risk factors for wound complications after internal Hemipelvectomy
Journal of Bone and Joint Surgery-british Volume, 2020Co-Authors: Koichi Ogura, Patrick J Boland, Nicola Fabbri, John H HealeyAbstract:Aims Although internal Hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or h...
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:Introduction In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications.
-
pelvic ring reconstruction with a double barreled free vascularized fibula graft after resection of malignant pelvic bone tumor
Archives of Orthopaedic and Trauma Surgery, 2015Co-Authors: Koichi Ogura, Minoru Sakuraba, Shimpei Miyamoto, Tomohiro Fujiwara, Hirokazu Chuman, Akira KawaiAbstract:In patients undergoing limb-salvage internal Hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal Hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal Hemipelvectomy with special reference to long-term complications. We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal Hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3–131 months). The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3–7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up. In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary.