Pelvic Ring Reconstruction With a Vascularized Pedicle Iliac Bone Graft for a Large Sacral Schwannoma

Abstract

A case of pelvic ring reconstruction with a vascularized pedicle iliac bone graft for removal of a huge sacral schwannoma is reported. It is necessary to reconstruct a pelvic ring when its integrity is impaired. Spinal instrumentation is essential for a temporary stability of the pelvic ring in the course of complete healing, which at times results in instrumentation failure. Several cases of pelvic ring reconstruction using vascularized fibular bone grafts have also indicated positive results attributable to their good blood circulation, but techniques with them are relatively complicated. We applied a vascularized pedicle iliac bone graft to the pelvic ring reconstruction after resection of a huge sacral schwannoma. When a stable pelvic ring was regained by using a lumbosacral instrumentation technique, a tricortical iliac bone graft with its vascular pedicle was harvested, transported into the dead space, and tied to the right residual sacrum and the left ilium. The vascularized graft healed rapidly, and continuity of the pelvic ring was regained. This method is effective for pelvic ring reconstruction in that it does not require microvascular techniques and rapid bone healing can be obtained.

The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

“…53,54 Previous reports have noted limb salvage with the use of a single or multiple vascularized fibula graft spanning from the ilium to the lumbar spine or across the bone defect. 44,[55][56][57] Our experience with the use of fibular grafts for spinal reconstruction alone, in the absence of concomitant pelvic reconstruction, was very positive with successful bony unions achieved in all but a single case. In addition, the average distance reconstructed surpassed previous studies and union times were comparable to several previous reports using vascularized bone.…”

“…42 The use of the vascularized pedicled rib graft was further popularized by Bradford who described a technique of anterior placement of the graft that resulted in rapid bony incorporation and decreased complications. 15,43 Posterior placement of the vascularized rib graft was recently reported by Wilden et al 39 Further variations of pedicled vascularized bone have included pedicled iliac crest bone graft for sacral reconstruction 44 and lumbosacral fusion 45 as well as free vascularized rib grafts for pelvic reconstruction. 46 While pedicled vascularized rib provides a technically straightforward and generally successful means of augmenting spinal reconstruction, this technique is inadequate for cases of infection, reconstruction following radiation, large tumor resections, and resections occurring outside of the thoracic vertebrae.…”

Presakral dev schwannom: Olgu sunumu ve literatür derlemesi

“…Semptomlar sıklıkla lumbosakral bölgede ağrı, alt ekstremitede radiküler ağrı, konstipasyon ve idrar retansiyonu olarak karşımıza çıkmaktadır [3]. Presakral tümörler asemptomatik dönemde rutin rektal muayene sırasında da saptanabilir [7,8].…”

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

“…Ultimately, 21 studies met criteria for systematic review (►Table 1) and subsequent pooled analysis was executed with 12 studies. 9,11,13,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]…”