To the Editor.—It was with great interest that we read the article by Lawton and De Pinto1 in the September 1987 issue of the Archives. There are numerous points in the article that warrant further discussion. First, the significant morbidity associated with bilateral hip disarticulation was not stressed. These patients have substantial blood loss, a high potential for infection with a large raw surface area and dead space, and a potential for significant loss of flaps. Furthermore, there was not enough emphasis placed on retaining the proximal femur with unilateral or bilateral disarticulation. Patients with bilateral total thigh flaps have substantial problems with vertical instability and require special preparation of a "bucket" to maintain balance in wheelchairs. In addition, with bilateral disarticulation, there is a substantial potential for developing perineal breakdown with all of their weight resting on this area. Lastly, there was no discussion regarding the use
DEMAS C, CLINTON M, BARWICK W. Risks of Bilateral Hip Disarticulation. Arch Surg. 1988;123(7):912. doi:10.1001/archsurg.1988.01400310126025
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