Anterior Flap Hemipelvectomy: Experience with Its Peformance in 8 Cases

Abstract

Objectives: Anterior flap hemipelvectomy is an unusual procedure used to treat tumors from the buttock and proximal posterior thigh. This study reviews the technique and analyzes 8 such operations.Methods: Charts from 1973 to 2001 were reviewed. The technique is described and demographics, histology, symptomatology, tumor status, blood transfusion, operative time, ICU time, use of neo-or adjuvant therapy, complications, patterns of recurrence and outcome were recorded.Results: The ratio male:female was 6:2. Seven patients were Caucasian, one was Asian. Median age was 47.5 years. Pain and swelling were the major complaints. Two patients had previous manipulation before referral. Most tumors were sarcomas. All patients had regional disease at diagnosis. All procedures had curative intent. Median operative time was 427 minutes. Median blood transfusion was 1200 mL. Maximum ICU permanence was 48 hours. Six patients received neo-or adjuvant therapy. The most frequent complication was phantom pain. Recurrences were local in 1 case and pulmonary in 4 cases. Median follow up was 10.5 months. Median survival was 21 months. There was no operative mortality.Conclusions: The anterior flap hemipelvectomy is a safe and effective procedure to treat gluteal or high posterior thigh tumors. It has a low rate of complications, and should be the reconstructive procedure of choice in such cases.

Adductor Myocutaneous Flap Coverage for Hip and Pelvic Disarticulations of Sarcomas with Buttock Contamination

“…Wound closure, however, presents a problem when tumor involvement of the buttocks and anterior proximal thigh compartment precludes the use of the standard posterior gluteus maximus flap or even the atypical anterior quadriceps muscle flap [5,7,8,10,11,13,20,21,24]. Free flaps [2, 4, 15-17, 22, 23, 25, 26] (eg, latissimus dorsi muscle, fillet leg flap), pedicled flaps from the ipsilateral lower extremity [1], and regional flaps from the abdominal wall [3,16,22] (eg, rectus abdominis and external oblique muscles) are options, but they are associated with technical difficulties and donorsite morbidities.…”