Buttock Amputation (Gluteal Amputation): Indications and Decision-Making

Gluteal amputation (hindquarter or hemipelvectomy) is a radical, life-saving procedure reserved for catastrophic conditions when limb salvage is impossible. Indications include:

• Necrotizing fasciitis / gangrene – Uncontrolled infection threatening sepsis
• Severe trauma – Crush injuries, high-voltage burns, mangled extremity
• Locally advanced malignancy – Sarcoma, recurrent rectal/gynecologic cancer invading gluteal compartment
• Refractory infection – Chronic osteomyelitis, prosthetic joint infection with sepsis
• Critical limb ischemia – Irreversible vascular occlusion with tissue loss

Decision-making involves a multidisciplinary team (trauma, vascular, oncology, plastic surgery, anesthesia, ethics, rehab). Preoperative counseling covers functional outcomes (wheelchair mobility, sitting balance), phantom pain risk, and psychosocial support. Postoperative rehab focuses on wound healing, seating systems, and community reintegration.