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

Abstract

<jats:p>This is a technical note of pelvic reconstruction performed by an advanced multidisciplinary team. The authors report a new 3-stage reconstruction of the hemipelvis after Type 3 sacrectomy involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients.</jats:p> <jats:p>The anterior stage of the procedure begins with a transabdominal approach to mobilize the viscera and to free up the tumor from the vessels. The posterior divisions of internal iliac vessels, the middle sacral vessels, and the lateral sacral vessels are then ligated. An anterior vertebrectomy is done at the appropriate level, followed by an anterior osteotomy through the lateral planed surgical margin of the sacrum close to the salvaged sacroiliac joint. The second stage includes a major sacral resection with lower-extremity amputation from the pubic symphysis through the intact side of the sacrum, ipsilateral pedicled fibula harvesting, and closure with an ipsilateral pedicled quadriceps flap. The final stage involves reconstruction with lumboiliac instrumentation. The pedicled fibular graft left from the second stage is then placed distally within the previously created iliopectineal docking site and proximally within the L-5 docking site.</jats:p> <jats:p>The authors believe that this is a feasible and reproducible technique with theoretical advantages that have to be proved in the long-term follow-up.</jats:p>

Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

“…About 25-32% malignant pelvic tumors have sacral infiltratio n[ 1 , 3 , 4 ]. In a bid to decrease rates of local recurrence and achieve wide resection margins, tumors extending to the sacrum were initially managed via hindquarter amputation, at severe cost of patient functionality and quality of lif e[ 5 ]. Encouragingly, limb-preserving procedures - primarily in the form of en-bloc tumor resection and reconstruction - emerged as viable surgical alternatives for pelvic sarcomas with sacral infiltration.…”