Abstract
Hemicorporectomy is a procedure where the lumbar spine and spinal cord, pelvic bones and contents, lower extremities and external genitalia are surgically removed. The rehabilitation process, in addition to being prolonged and costly, is challenging. This article reports the rehabilitation process for hemicorporectomy and shows the innovative solutions for mobility for this disability for two cases of paraplegic patients: case 1 due to traumatic spinal cord injury due to firearm injury and case 2 due to lumbosacral myelomeningocele. They presented chronic pressure ulcer which evolved to neoplastic transformation. (squamous cell carcinoma - Marjolin's ulcer). The cases were submitted to L4 hemicorporectomy and were rehabilitated to ensure the right to mobility independence for activities of daily living; social inclusion; prevention of comorbidities and pluralization of disabilities. The rehabilitation involved the elaboration of a new prosthesis for the hemibody and improvement of functional capacity, within a gain of 6 - 11 points in the Functional Independence Measure (FIM). The principal changes happened in social interaction, locomotion and transfers to a bed/chair and toilet. Despite the body transformation, patients show gains in quality of life mainly for the social domain of World Health Organization Quality of Life instrument-brief version (WHOQOL-bref). In general, there is an increase in the scores of this instrument from 1.78% -19.25%. The evolution of social inclusion through the International Classification of Functioning, Disability and Health (ICF) reveals that patients are able to resume social, working, academic-professional life and recreation and leisure activities, reducing the number of severe and complete qualifiers from 90.91 to 60% when using the products appropriate assistive devices. Hemicorporectomy can be a therapeutic option for those in need, as it provides functionality without the need for caregivers and resumes educational, professional, economic and social aspects with gains in quality of life.
Highlights
Hemicorporectomy, translumbar amputation or translumbectomy is a procedure indicated to save someone in severe distress and risk of death,[1,2] where the spine, lumbar spinal cord, pelvic bones and contents, lower extremities and external genitalia are removed surgically.[3,4]
In order to have a better discussion on hemicorporectomy, despite the little data in the literature on the subject, we can compare and rely on patients with proximal amputations, such as hip disarticulation and hemipelvectomy - which are closer to hemicorporectomy
These amputations have a higher morbidity, in addition to complications such as wound infections and flap necrosis in the postoperative period and rarely use prostheses,[31] which is compatible with our findings
Summary
Hemicorporectomy, translumbar amputation or translumbectomy is a procedure indicated to save someone in severe distress and risk of death,[1,2] where the spine, lumbar spinal cord, pelvic bones and contents, lower extremities and external genitalia are removed surgically.[3,4]. Case-2 (Figure 13) showed functional gains for sitting, home mobility (moving around within the home), relationship with the goods and services market, informal relationships, work (paid) and leisure activities It maintained restrictions on participation in aspects related to community mobility (individual or collective, as a passenger or driver) and for intimate. This patient returned to work as a graphic designer, resumed studies and undertook digital services in the financial and stock market Despite his financial success, environmental aspects of the city where he lives hinder his greater participation (lack of public transport, of streets properly paved for wheelchair users and the presence of unfavorable geographic relief with steep and irregular hills and valleys). The adherence was assessed by demonstrating the practice of exercise and the absent of wounds
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