Predictors of Complications and Outcomes of External Hemipelvectomy Wounds: Account of 160 Consecutive Cases

Abstract

External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

Anatomical Difficulties of Hemipelvectomy and Sacrectomy from the View of Vascular Complex

“…Hemipelvectomy and Sacrectomy are infrequently performed and associated with a high rate of postoperative mortality and morbidity [1][2][3][4][5]. The difficulty of these procedures are contributed by a lot of factors including the anatomical complexity, the proximity of important organs and structures including major nerves, viscera, and major vessels, consistency of huge tumor, necessity of intraoperative postural change, pelvic ring reconstruction and high rate of postoperative complications [2,[5][6][7].…”

“…Wound complications are particularly common [3,4,11]. The flap necrosis rates are reported up to 38% [3,4,12]. The wound infection rates are up to 79% [3,4,12,13].…”

Management of infection following reconstruction in bone tumors

“…Other factors include prolonged operating time, wide surgical exposure, use of chemotherapy/radiotherapy, proximity of the rectum and genitourinary tract, size of the implant, and blood supply to the skin flap. 37,6,39,[45][46][47][48] Regarding infection rates with regard to specific diagnosis, sarcomas demonstrated the highest infection rate of 21.7% when compared to metastatic or non-metastatic disease (Table 2). 36 Usually high infection rates are seen after …”

“…80,81 High infection rates ranging from 15% to 50% have been reported after pelvic tumor resection surgeries. 47,[82][83][84] Factors responsible for the high incidence of infection in allogenic bone graft pointed out by Witso et al 85 include highly porous, non-cellular, and avascular foreign bodies that are prone to bacterial adhesion. Once bacteria attach, they secrete a thick glycocalyx matrix rendering them inaccessible to immune surveillance and local cellular defense mechanism.…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…The procedure may also involve resection of the ipsilateral lower extremity (external hemipelvectomy or hind-quarter amputation) or a limb sparing procedure (internal hemipelvectomy) [75]. Postoperative mortality varies from 0 to 8% [76][77][78][79][80][81][82][83][84]. As expected, intraoperative hemorrhage can be significant during these procedures with reported blood loss ranging from 400 cc to 12,100 cc [80,82,83,[85][86][87][88][89].…”