ref: King and Steelquist "Transiliac amputation" JBJS 25: 351, 1943
Operative Technique
- Attention to perineal hygiene : bowel prep with enemas, insert urinary catheter, anus stitched closed or sealed off with adhesive drape
Anterior Part
- Incision from pubic tubercle along inguinal ligament, over iliac crest to level of iliac resection, turn inferiorly and forward around the greater trochanter then posteriorly and medially around the gluteal fold. Detach abdomial muscles and inguinal ligament from the iliac crest + open the iliac fossa between peritoneum and iliacus. At pubis sever the inguinal ligament and tendon of rectus abdominis
- Spermatic cord and abdominal contents retracted medially
- Ligate external iliac artery + vein. If posterior incision includes gluteus maximus, save the hypogastric artery
Perineal Part
- Abduct leg, expose the rami, subperiosteally remove the Ischio-cavernosus and transversus perinei. Divide symphysis
Posterior Part
- Expose the posterior and inferior edges of Gluteus maximus, divide its aponeurosis in line with skin, reflect it proximally to expose Gluteus medius + minimus. Divide Pyriformis and ligate the sciatic nerve
- Pass a Gigli saw around the greater sciatic notch – section the ilium at the desired position – this mobilises the innominate bone – rotate it externally for wider intrapelvic exposure
- ligate and divide obturator vessels and nerves and divide the psoas at the level of the SI joint. Divide levator ani from its pubic origin – this frees the entire extremity
- Bring Gluteus maximus flap anteriorly and suture it to the rectus abdominis, lateral abdominal, Quadratus lumborum and psoas muscles. Close skin flap over drains