PubMed · 14893515
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B R GORBON. 1951. [Inter-scapulo-thoracic disarticulation].. https://pubmed.ncbi.nlm.nih.gov/14893515/
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Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur.
Introduced in the 18th century, hip disarticulation was considered to be one of the most radical operations performed for trauma or disease of the lower limb. The high morbidity and mortality associated with it ensured that it was a rarely performed procedure. It is fortunate that it remains extremely uncommon to the present day. Since the first successful hip disarticulation was described, a number of important advances have occurred. General medical care has improved dramatically and the development of anaesthesia, analgesics, antibiotics and blood transfusions has resulted in greatly decreased morbidity associated with this dramatic operation. This review on the history of hip disarticulation outlines the surgical evolution of the operation, the indications for its use and the techniques used. It draws on the early experiences and preferred techniques of the surgeons of the 19th century, with some discussion on the methods employed to reduce intraoperative haemorrhage. Further development of techniques in the 20th century is also described together with discussion on the evolution of hindquarter amputation.
Intraoperative, angiographic and preparation findings within lower leg and foot of a child with tibial hemimelia type IA according to Jones are presented. Disarticulation at the knee has been performed bilaterally. Dysplasia of the distal femur, absence of the patellae, extensor apparatuses and cruciates were found. Amputated preparation revealed fibrotic band attached via interosseus membrane to the fibula, presence of unidentified muscle attached to the tip of the lateral malleolus, doubled tibialis anterior muscle on one side and accessory extensor digiti II. Talocalcaneal synostosis was bilateral, abnormal cuboids and accessory bones were found. Popliteal artery division was found at the mid-length of the fibula. Unidentified thick nerve passed the lateral ankle and divided at the sole of the foot.