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Damage control hip disarticulation: two-stage operation with index creation of a large medial flap for the septic hip
  1. Christina Colosimo1,
  2. Charles Fredericks2,
  3. James R Yon3,
  4. John C Kubasiak2,
  5. Faran Bokhari4,
  6. Stathis Poulakidas4
  1. 1Department of Trauma, Sky Ridge Medical Center, Lone Tree, Colorado, USA
  2. 2Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
  3. 3Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, Colorado, USA
  4. 4Department of Trauma And Burn, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  1. Correspondence to Dr Christina Colosimo; chris.colosimo{at}gmail.com

Abstract

Background 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.

Methods 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.

Results 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.

Discussion 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

  • amputation
  • debridement
  • hip fractures
  • infections
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Footnotes

  • Contributors CC helped with the literature search and writing of the article. CF helped with the data collection and literature search. JY helped write the article. JCK helped with the project design, data analysis and editing. FB and SP both helped with project design and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in the submitted article are her own and not an official position of the institution.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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