Amputation through the middle 1/3 and lower 1/3 of the thigh

Amputation and joint dissection is a destructive procedure that has long been regarded as the primary means of surgical treatment of malignant bone tumors, saving the lives of patients at the expense of limbs. In recent years, with the widespread use of effective chemotherapeutic drugs and the advancement of surgical techniques, especially the extensive extensive resection of the limbs, attempts to treat malignant bone tumors have yielded satisfactory results, and the indications for amputation surgery have been reduced. According to the new concept of localized tumor resection, the role of amputation and joint dissection in the treatment of malignant bone tumors should be re-recognized. Due to the different planes of amputation, amputation or joint dissection may be radical tumor resection, or extensive tumor resection, or marginal tumor resection. Therefore, amputation or joint dissection does not always achieve radical resection of malignant bone tumors. Nevertheless, amputation and joint dissection are still one of the main methods to achieve radical resection of malignant bone tumors. When the limb is indeed unable to be retained, the amputation or joint dissection should be performed decisively. Treating diseases: old rotten legs Indication Amputation through the 1/3 of the thigh and the middle and lower 1/3 is applicable to: 1. A malignant tumor of the lower leg or knee joint. 2. Severe congenital calf or knee deformity, loss of function. Preoperative preparation 1. Biopsy must be performed before amputation to obtain a positive pathological diagnosis. 2. Conventional whole body radionuclide bone scan and chest orthotopic X-ray film, except for distant metastasis of the tumor. 3. Select CT scan, MRI and angiography to determine the extent of bone and soft tissue involvement, and determine the amputation or joint plane. 4. The general condition is poor, and those with anemia and malnutrition should be corrected before surgery. 5. Determine whether chemotherapy is performed before surgery based on the determined chemotherapy regimen. 6. For those who have decided to amputation or joint disengagement, they must obtain the consent and signature of the parents, and then report to the higher-level medical administrative department for approval before surgery. Surgical procedure Incision In the predetermined osteotomy plane, front and rear isometric flaps are designed, each flap having a length at least corresponding to the radius of the planar thigh. First along the medial line of the inner thigh, starting from the proximal end of the osteotomy plane 2 to 3 cm, cut the skin distally, and turn to the outer midline of the thigh in an arc shape, and then extend to the proximal end, ending at the same plane as the starting point of the medial incision. The subcutaneous tissue and the deep fascia are cut to form flaps of equal length and shape. 2. Cut off muscles and femoral arteries and nerves The anterior and posterior flaps are separated proximally to the osteotomy plane and turned to the proximal end, and the sartorius muscle is retracted to find the saphenous nerve and cut it sharply. Then clamp, cut and double ligature the femoral artery. Behind the femur, in the gap between the adductor muscle, the biceps femoris and the quadriceps muscle, the deep arteriovenous vein was separated, and clamping, cutting and double ligation were also performed. Because the anterior medial thigh muscle is thick and the contractile force is strong, it should be cut obliquely below the fascia retraction. For the posterior muscle of the thigh, the distal end of the fascia is retracted. The sciatic nerve was then gently pulled distally, and after intrathecal injection with 0.5% procaine, the sciatic nerve was severed with a sharp blade at the proximal end of the osteotomy plane. If there is bleeding at the end, it is ligated with a thin wire and then retracted to the plane above the osteotomy. 3. Osteotomy and closed stump The cut muscles are pulled to both ends, the periosteum is cut in a ring shape and peeled off to the distal end, and the femur is cut transversely, the distal end of the cut limb is removed, and the sharp edge of the femoral stump is removed with the callus. Then, the hole is drilled in the proximal side of the femoral stump, and the bone debris in the wound is washed with physiological saline, and the hamstring and the adductor muscle are sutured and fixed by the bone hole through the absorbable line or the chrome gut line. At this point, relax the tourniquet, completely stop the bleeding, cover the femoral stump with the quadriceps, suture the shallow deep fascia and the deep fascia on the posterior side of the thigh, and leave a vacuum suction tube in the incision. The subcutaneous tissue and skin are sutured in layers. complication 1. Hemorrhage and hematoma formation. 2. Joint contracture. 3. Phantom limb pain. 4. Neuroma and residual limb pain.