External Hemipelvectomy Pelvic Ring Stabilization: The Unique Application of Chimeric Lower Extremity Pedicled Fillet Flaps

Abstract

Reconstruction of large external hemipelvectomy oncologic defects of the proximal limb and trunk remains a formidable surgical challenge. Large pelvic defects can result in exposed bones, neurovascular structures, and surgical hardware due to a paucity of soft tissue coverage. When the size of a hemipelvectomy defect precludes coverage by local posterior- or anterior-based hemipelvectomy flaps, the use of other local flaps must be considered before resorting to free tissue transfer. The rectus abdominis myocutaneous pedicled flap is the most commonly used locoregional flap for soft tissue coverage of large hemipelvectomy soft tissue defects. The concept of utilizing parts from otherwise nonsalvageable limb components in reconstruction is well described in the literature and referred to as the “spare parts” concept. Utilization of these distal “spare parts” has the advantage of obtaining sufficient soft tissue coverage while concurrently obviating additional donor-site morbidity. These spare parts can be utilized as either pedicled or free fillet flaps. This paper describes the unique use of in-continuity chimeric pedicled fillet flaps of the lower extremity to reconstruct and stabilize the pelvic ring, to obliterate dead space, and to provide overlying soft tissue coverage.

Keywords

external hemipelvectomy - fillet flaps - microvascular surgery

• References

• 1 Ver Halen JP, Yu P, Skoracki RJ, Chang DW. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg 2010; 125: 913-922
• 2 Chang DW, Lee JE, Gokaslan ZL, Robb GL. Closure of hemicorporectomy with bilateral subtotal thigh flaps. Plast Reconstr Surg 2000; 105: 1742-1746
• 3 Senchenov A, Moran SL, Petty PM , et al. Soft tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg 2009; 124 (1) 144-155
• 4 Küntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg 2001; 108: 885-896
• 5 Boehmler JH, Francis SH, Grawe RK, Mayerson JL. Reconstruction of an external hemipelvectomy defect with a two-stage fillet of leg-free flap. J Reconstr Microsurg 2010; 26: 271-276
• 6 Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 2004; 114: 1457-1466
• 7 Butler CE. Reconstruction of an extensive hemipelvectomy defect using a pedicled upper and lower leg in-continuity fillet flap. Plast Reconstr Surg 2002; 109: 1060-1065
• 8 Ross DA, Lohman RF, Kroll SS , et al. Soft tissue reconstruction following hemipelvectomy. Am J Surg 1998; 176: 25-29
• 9 Knox K, Bitzos I, Granick M, Datiashvili R, Benevenia J, Patterson F. Immediate reconstruction of oncologic hemipelvectomy defects. Ann Plast Surg 2006; 57: 184-189
• 10 Yamamoto Y, Takeda N, Sugihara T. Pelvic ring reconstruction with a vascularized bone flap of femur. Plast Reconstr Surg 1997; 100: 415-417
• 11 Levine AM, Eismont FJ, Garfin SR, Zigler JF. Spine Trauma. Philadelphia: W.B. Saunders; 1998
• 12 Zhang HY, Thongtrangan I, Balabhadra RS, Murovic JA, Kim DH. Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus 2003; 15: E5
• 13 Gunterberg B, Romanus B, Stener B. Pelvic strength after major amputation of the sacrum. An exerimental study. Acta Orthop Scand 1976; 47: 635-642
• 14 Mavrogenis AF, Soultanis K, Patapis P, Papagelopoulos PJ. Anterior thigh flap extended hemipelvectomy and spinoiliac arthrodesis. Surg Oncol 2011; 20: e215-e221 DOI: 10.1016/j.suronc.2011.07.001.
• 15 Beck LA, Einertson MJ, Winemiller MH, DePompolo RW, Hoppe KM, Sim FF. Functional outcomes and quality of life after tumor-related hemipelvectomy. Phys Ther 2008; 88: 916-927
• 16 Apffelstaedt JP, Driscoll DL, Spellman JE, Velez AF, Gibbs JF, Karakousis CP. Complications and outcome of external hemipelvectomy in the management of pelvic tumors. Ann Surg Oncol 1996; 3: 304-309
• 17 Yari P, Dijkstra PU, Geertzen JHB. Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands. Clin Rehabil 2008; 22: 1127-1133
• 18 Daigeler A, Lehnhardt M, Khadra A , et al. Proximal major limb amputations—a retrospective analysis of 45 oncological cases. World J Surg Oncol 2009; 7: 15