Hip disarticulation with pedicled total leg fillet flap for recurrent fungating sarcoma

Abstract

Soft tissue sarcomas may be treated with limb-sparing procedures in the majority of cases; however, certain cases involving significant tumor spread and fungation may call for amputation. In the thigh, hip disarticulation typically involves a pedicled gluteus maximus flap or a pedicled anterior quadriceps flap. In this case report, we describe a rare situation in which the anterior flap, posterior flap, and adductor flap musculature were contaminated with tumor; therefore, a hip disarticulation was performed applying a pedicled total leg fillet flap for closure. Eighteen months after treatment, the patient continues to have no local recurrence of disease, a stable flap site, and ambulates with a walker. We present this amputation and closure method as a potentially effective modality in treating extensive oncologic disease of the proximal lower extremity.

Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding

“…Therefore, the patient and surgeon should decide on the nature of the operation and complications. The lower-extremity fillet flap is generally prepared from nonfunctional lower extremities and is used as a pedicled or free flap in the repair of large tissue defects in the pelvis and sacral regions resulting from tumor excision and crush injury 6,9–11,13–17,31–34 . This flap has rarely been used for extensive stage IV pressure sore repairs 1,2,3 .…”

“…The lower-extremity fillet flap is generally prepared from nonfunctional lower extremities and is used as a pedicled or free flap in the repair of large tissue defects in the pelvis and sacral regions resulting from tumor excision and crush injury. 6,[9][10][11][13][14][15][16][17][31][32][33][34] This flap has rarely been used for extensive stage IV pressure sore repairs. 1,2,3 The entire lower-extremity fillet flap (with the foot) has rarely been used to repair defects resulting from crush injury, tumor excision, and wide stage IV pressure sores.…”