AMPUTATION OF LOWER LIMB AND HIP
Aggressive tumors, infection, and necrosis may necessitate a disarticulation of the hip or a hindquarter amputation. With hip disarticulation, the entire femur is removed and a large posterior skin flap is preserved and brought forward. The surgeon should attempt to pre-serve the gluteus muscles, which can serve as a cushion for sitting and for supporting a lower limb prosthesis.
Hindquarter amputation, or hemipelvectomy, includes removal of the entire lower limb and the entire innominate bone of the pelvis. Three levels of resection have been described. The standard approach is a disarticulation through the sacroiliac joint. In a modified, or conservative, approach, the line of resection is just lateral to the sacroiliac joint, preserving a small rim of the ilium, When the tumor extends across the sacroiliac joint, an extended resection through the sacral foramina may be necessary. Regardless of the level of ilium resection posteriorly, the surgeon tries to preserve some gluteus muscles to provide coverage of the abdominal organs, which will otherwise be vulnerable to injury after resection of the ilium.