Immediate Reconstruction of Oncologic Hemipelvectomy Defects

Abstract

Soft tissue reconstructions after extensive pelvic resections always present as complex reconstructive problems. Reconstruction is dictated by the size of the defects and by tissue availability. The extent and type of resections vary according to tumor size and location. In our experience, local pedicled muscle-based flaps, if available, usually provide adequate tissue mass to eliminate dead space, cover the extent of the wound, and close the retroperitoneal defect. Microvascular tissue transfer is always an option but was reserved in our series for cases with no suitable local alternative.

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

“…Another pedicled flap is that of the external oblique muscle, receiving its blood supply from the last six intercostal arteries, which can be rotated inferiorly to cover the defect [3]. These relatively tedious surgeries, however, are accompanied by complications, such as serous leaks, hematoma, abscess formation, and flap failure [9,16,22], and sometimes also require the need for split thickness skin grafting of the donor site and increased operative time.…”

“…Unconventional closure techniques include island pedicle flaps, such as that of the ipsilateral rectus abdominis muscle, pedicled on the inferior epigastric vessels and mobilized and tunneled through a narrow abdominal skin bridge [9,16,22]. Another pedicled flap is that of the external oblique muscle, receiving its blood supply from the last six intercostal arteries, which can be rotated inferiorly to cover the defect [3].…”

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

“…13,14 Muscle-based flaps are also known to provide an adequate tissue mass for eliminating dead space as well as the skin defect in cases of oncologic hemipelvectomy defects. 15 Muscle-based flaps have proven to be of great value in the reconstruction of complex wounds, primarily because of their rich vascular supply and superior resistance to infection. 16 The current case was complicated by exposure of the endoprosthesis and the bone cement, with a resultant skin defect after debridement.…”

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

“…Hence, pedicled or free musculocutaneous flaps have been used to tackle wound compications. 34,36,37,47 The vertical rectus abdominis muscle flap (VRAM) is increasingly becoming more popular in the closure of large sacral defects given its abundant supply of well-vascularized tissue, reliability, and simplicity of dissection.…”