Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review

Abstract

Background and objectives: Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.

Methods: A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications.

Results: Thirteen patients were included with median age of 39 years (range 13-78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap.

Conclusions: Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.

Figure 1

49-year-old man with late presentation of osteosarcoma involving ilium and ischium. He had hemipelvectomy and reconstruction with anteromedial thigh fillet flap. (a) Preoperative photo showing large swelling over the left hip and gluteal area. (b) Intraoperative picture showing the proposed area for fillet thigh flap to be harvested. (c) Flap was completely raised including adductor muscle group, gracilis, and sartorius. Left attached by the skin (proximal anteromedial area of groin) and its main vascular pedicle. (d) Early after procedure (Inset—Day 10 post op.).

Figure 2

19-year-old man with a diagnosis of peripheral primitive neuroectodermal sarcoma. He had right hemipelvectomy and reconstruction with mesh and anteromedial fasciocutaneous flap based on perforators from superficial femoral vessels. (a) Pre-op photo of the large swelling over the hip and gluteal areas. (b) Dissection of the pedicle showing the intact cutaneous perforators to the skin. Inset-amputated limb showing area where the flap has been raised. (c) Peritoneal cavity is supported with mesh. Inset shows defect and the flap. (d) Immediate post op photo showing the flap inset.

Figure 3

Case of 24-year-old lady with recurrent osteosarcoma previously treated with limb sparing surgery and modified hip arthroplasty, completed radiotherapy and chemotherapy. She had recurrent eight months later and external hemipelvectomy was done. (a) Preprocedure showing large swelling left buttock area. (b) The fasciocutaneous flap over the anterolateral thigh is raised on its pedicle-lateral circumflex femoral vessels. (c) Flap has been completely raised on its pedicle and inset. (d) Lateral and anteroposterior view one month post op.