Prosthetic management of hemicorporectomy patients : new approaches

Functional outcome with hemicorporectomy prosthetic management has improved little in the last 20 years. Patient expectations for independence, comfort, and cosmesis have been disappointed with traditional bucket designs. This report describes the prosthetic management of a paraplegic patient who underwent hemicorporectomy at T12 secondary to complications from a lumbar ependymoma. Four successive prostheses were developed using foam and resin combinations, computer-assisted pressure monitoring, and interdisciplinary team feedback regarding design and fabrication. A total-contact bucket with removable liner was created, allowing management of the ileal diversion and colostomy. Prosthetic legs were attached to improve wheelchair balance and cosmesis. In his final prosthesis, the patient's function and appearance was equivalent to a well-rehabilitated midthoracic spinal cord trauma patient. Sitting tolerance exceeded 12 hours a day. Each prototype is discussed, including design, materials, fabrication process, patient acceptance and functional independence, and complications.