Colosimo Christina, Fredericks Charles, Yon James R, Kubasiak John C, Bokhari Faran, Poulakidas Stathis
Department of Trauma, Sky Ridge Medical Center, Lone Tree, Colorado, USA.
Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Trauma Surg Acute Care Open. 2020 Sep 1;5(1):e000502. doi: 10.1136/tsaco-2020-000502. eCollection 2020.
Although rarely performed, hip disarticulation (HD) is usually used for the patient with a non-viable leg who is also in extremis. HD was first used for trauma and infection; however, the technique was perfected during the age of hindquarter amputation for osteosarcomas. The operation performed by most surgeons today is still based on the oncological principles of high vessel control and ligation. When this approach has been used in the overwhelmingly infected or mangled extremity, it has resulted in high mortality rates. During the last 20 years, the concept of damage control operation has been embraced by emergency surgeons in all fields. We sought to extrapolate this concept and to apply it to the non-viable lower extremity.
We describe a new concept of damage control HD, review the technique and discuss our consecutive series of nine patients who underwent the procedure for trauma or necrotizing infection without flap dehiscence or mortality.
All patients survived to hospital discharge. At time of discharge or at follow-up, six of the nine patients were able to transfer to a wheelchair.
Proper disarticulations for infection need to address these two operative and postoperative issues: damage control debridement with creation of sufficient flap size and thorough postoperative wound care.Level IV.
尽管髋关节离断术（HD）很少实施，但通常用于病情危急且下肢无法存活的患者。HD最初用于创伤和感染；然而，该技术在骨肉瘤后躯截肢时代得到完善。如今大多数外科医生所进行的手术仍基于高位血管控制和结扎的肿瘤学原则。当这种方法用于严重感染或毁损的肢体时，导致了高死亡率。在过去20年里，损伤控制手术的概念已被所有领域的急诊外科医生所接受。我们试图推断这一概念并将其应用于无法存活的下肢。
我们描述了损伤控制HD的新概念，回顾了技术并讨论了我们连续收治的9例因创伤或坏死性感染接受该手术的患者，这些患者均未出现皮瓣裂开或死亡。
所有患者均存活至出院。出院时或随访时，9例患者中有6例能够转移至轮椅。
针对感染进行适当的离断术需要解决这两个手术和术后问题：进行损伤控制清创并创造足够的皮瓣大小以及术后进行彻底的伤口护理。四级。
