Reconstruction of the Pelvic Ring with Vascularized Double-Strut Fibular Flap following Internal Hemipelvectomy

Abstract

Use of a vascularized double-strut fibular bone flap for pelvic ring reconstruction is effective in facilitating early ambulation and restoring normal to near-normal gait in patients undergoing internal hemipelvectomy.

Surgical Technique: Iliosacral Reconstruction With Minimal Spinal Instrumentation

“…Furthermore, there is no reconstruction of the abductor muscles to allow for better function of the hip. Some authors have described constructs using strut grafts [1,2], vascularized iliac pedicles [11], or vascularized fibulas [4,15,20] to connect remaining periacetabular bone to the sacrum. Although these techniques address the problems produced by not reconstructing the pelvis they have tended to be technically challenging, can result in high complication rates, and may not provide reliable union [2,15].…”

“…A Type I resection includes wide excision of a portion, or the entirety of, the ilium, and a Type I-S resection involves resection of a portion of the sacrum [9]. Many authors [1,2,4,11,15] have suggested different strategies to deal with the discontinuity of the pelvis. Some have forgone any reconstruction of Type I resections [2,8], leaving the pelvic ring in discontinuity.…”

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

“…7,11,48,61 Autologous bony reconstruction of the pelvis using fibula has been described in the literature. 2,11,18,41,48 Yajima and Tamai reported 2 cases of pelvic reconstruction using double-strut vascularized fibula flaps. 59 Sakuraba et al 48 reported their experience with 5 cases of Type I and Type II hemipelvectomy defects that were reconstructed with double-barreled vascularized fibula flaps.…”

“…7,9,11,[14][15][16]20,24,30,39,48,61 Usually a free vascularized fibula flap is used. 7,11,48,61 Autologous bony reconstruction of the pelvis using fibula has been described in the literature. 2,11,18,41,48 Yajima and Tamai reported 2 cases of pelvic reconstruction using double-strut vascularized fibula flaps.…”

“…Fibular grafting of the pelvic girdle after tumor resection has been previously described either as a free vascularized autograft or as nonvascularized allograft or autograft. 2,11,18,28,48 We report a new 3-stage Type 3 sacrectomy and reconstruction of the hemipelvis involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients. The first patient (Case 1), a 39-year-old woman who had a primary bone tumor of the sacrum (fibroblastic sarcoma) with a pelvis extension (Fig.…”