Hemipelvectomy and hemicorporectomy for decubitus ulcers: A retrospective cohort review of patient outcomes and mortality

Background

Focal soft-tissue and bony injuries secondary to pressure can result in significant morbidity, including sepsis and in some cases, death. In the setting of severe wounds or recalcitrant infection, an infrequent modality of treatment is a pelvic amputation such as hemipelvectomy or hemicorporectomy. There is little data to guide the perioperative management and optimization prior to the procedure.

Methods

Patients with decubitus ulcers who underwent hemipelvectomy or hemicorporectomy at the University of Colorado and had follow-up from 2012 to 2021 were identified. Patients were categorized as “planned” or “emergent” based on sepsis criteria and performing the procedure within 90 days of index admission.

Results

Nine patients met criteria for inclusion. Three underwent hemicorporectomy, six underwent hemipelvectomy with one patient additionally undergoing hemipelvectomy of the contralateral side (ten total cases). Of these 10 cases, 90% reported complication and 40% had recurrence. Five patients required revision with “emergent” patients requiring on average 2.8 revisions and planned cases requiring 1.0 (p = 0.15). “Emergent” cases had lower albumin levels versus “planned” (2.3 g/dl, 3.3 g/dl p = 0.02) as well as 75% mortality (3/4) compared to 0% mortality (0/6) (p = 0.03).

Conclusions

Hemipelvectomy and hemicorporectomy represent a morbid treatment modality for recalcitrant decubitus ulcer. In the emergent setting in which patients are ill and significantly deconditioned it can have significant mortality. In those able to be staged and optimized with additional perioperative planning, recurrence and revision rates remain high, but mortality decreases significantly.

Level of Evidence

III.