Intractable
decubitus ulcers and femoropelvic
osteomyelitis are rare sequelae of
paraplegia.
Therapy for these conditions ranges from the simple to the complex, including
wound debridement and care, alimentary and urinary tract diversion, hip
disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative
therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting
sepsis;
marasmus; hip and knee flexion
contractures; suppurative sacral and femoropelvic
decubitus ulcers, exposed bone, and
osteomyelitis; and fecal and
urinary incontinence. Pre-operative nutritional supplementation,
wound debridement and care, and psychological counselling were provided. Hemicorporectomy was performed, including
colostomy, ureteroileal conduit,
gastrostomy, and translumbar
amputation. Several anatomical, physiological, and operative-technical perspectives are emphasized: a two-staged approach may be preferable--at the first setting an intra-peritoneal exploratory celiotomy with alimentary and urinary tract diversion; and at the second setting an extra-peritoneal hemicorporectomy; preservation of abdominal wall musculature and fasciae to facilitate
wound closure; sequential and bilateral
ligation of the arteriae et venae iliaca communis; translumbar
amputation between the fourth and fifth lumbar vertebrae; extirpation of the fourth lumbar processus spinosus vertebrarum; closure of the dura mater and translation of musculi sacrospinalis into the vertebral canal; avoidance of hypervolemia and
hyperthermia; avoidance of
wound pressure;
testosterone replacement
therapy for
eunuchism; and physical and occupational rehabilitation including adaptation to a customized bucket
prosthesis.