Hemicorporectomy.

In hemicorporectomy, or translumbar amputation, the bony pelvis, pelvic contents, lower extremities, and external genitalia are removed following disarticulation of the lumbar spine and transection of the spinal cord. Malignancies of the pelvic organs, skin, or musculoskeletal structures, usually locally advanced, may be indications for hemicorporectomy. The absence of systemic metastasis must be demonstrated before considering hemicorporectomy. Sacral decubitus ulcers and other complications of paraplegia represent the most frequent benign indications. Hemicorporectomy is a complex, multistep procedure with significant physiologic and psychologic implications. Postoperative morbidity and mortality rates are high, partly because of the complexity of the procedure itself and partly due to the underlying disease. Detailed planning, from preoperative evaluation to rehabilitation, is the key to a successful outcome. The procedure may be carried out in one stage or in multiple stages, depending on the clinical circumstances. Multidisciplinary collaboration of many health care professionals should be part of the planning process and must be carefully coordinated. Postoperative management requires particular attention to fluid replacement, temperature control, and pulmonary care. Posthospitalization rehabilitation includes the design and construction of a bucket prosthesis. Long-term management issues involve hypertension, weight gain, temperature control, stoma management, and skin care.