hip dissection

1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. Treatment of diseases: congenital venous malformation, limb hypertrophy syndrome, bone tumor Indication 1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation The incision is close to the perineum. To avoid contamination of the incision, clean enema and drug bowel preparation should be done before surgery. Surgical procedure 1. Position: supine position, the side of the pelvis and waist are padded with sandbags to make the hips out of bed. The penis and scrotum are glued to the contralateral lower abdomen with a strip of tape. 2. Incision: The incision begins with the anterior superior iliac spine, vertically downward and then bent to the medial side, parallel to the inguinal ligament, until the adductor muscle is stopped 5 cm below, and then curved back and down to 5 cm below the ischial tuberosity, continuing outward Down to 8 cm below the greater trochanter, finally, the arc is upward and connected to the initial incision below the anterior superior iliac spine. Cut the skin according to the above incision. 3. Cutting the anterior and medial tissues: After cutting the skin, it is separated upwards to the inguinal ligament. Separate the femoral artery, vein, and nerve, and cut it after routine treatment. Cut off the start of the sartorius and rectus muscles and turn to the far side. The pubis muscle was transected 2 cm below the pubic bone. Then rotate the thigh externally, cut the iliopsoas muscle at the small rotor, and turn it to the near side. The starting point of the gracilis and adductor muscles is then cut from the pubic tuberosity and the subsacral branch. There is a branch of obturator blood vessels between the pubis and the obturator muscles and the short external rotator, which needs to be ligated and cut. 4. Cut off the outer and posterior tissues: After cutting the medial and medial tissues, the legs are taken in and rotated internally, and the gluteus medius and gluteal muscles are cut from the greater trochanter. The tensor fascia lata was cut along the incision of the flap and the gluteus maximus was cut at the femoral gluteal muscle. The flap and the gluteal muscle flap are turned up together, and the sciatic nerve is exposed and separated, and cut off after conventional treatment. The attachment portion of the short external rotator muscle (the piriformis, the infraorbital muscle, the obturator muscle, the obturator muscle, and the femoral muscle) was cut from the rotor portion. Finally, the biceps, semitendinosus and semi-membrane muscles are cut off from the ischial tuberosity, the hip joint capsule is cut open, and the round ligament is cut to break the diseased limb. 5. Stitching: Completely stop bleeding and rinse the wound. The gluteal muscle flap was sutured to the adductor muscle, the pubis muscle, and the inguinal ligament. The incision was deeply treated with a negative pressure drainage tube and sutured in layers. complication joint pain.