Soft-Tissue Reconstruction of External Hemipelvectomy Defects

Abstract

Hemipelvectomy is associated with high wound morbidity. When the hemipelvectomy flap has a musculocutaneous design, hernias are exceedingly rare. Although immediate reconstruction is accomplished with a hemipelvectomy flap in the vast majority of cases, secondary reconstructions are often required for management of wound complications. For large defects, a contralateral inferiorly based rectus abdominis muscle or musculocutaneous flap is the reconstruction of choice. The rectus abdominis muscle should therefore always be preserved in hemipelvectomy patients by careful preoperative planning, especially when creation of an ostomy is considered.

Immediate soft-tissue reconstruction using a rectus abdominis myocutaneous flap following wide resection of malignant bone tumours of the pelvis

“…10 Several other authors have also recently reported similarly high rates of wound complications following surgery for pelvic tumours. 2,5,9,11 In a study of 160 patients who underwent primary closure of the wound following hemipelvectomy, Senchenkov et al 12 found that wound complications were the most common causes of post-operative morbidity, including infection in 62 patients (39%) and partial flap necrosis in 41 (26%). In a series of 110 patients after resection for pelvic sarcomas, Hillmann et al 2 found that 44 (40%) had wound complications such as infection, skin problems or haematoma formation.…”

“…[3][4][5][6][7][8] An overall rate of wound complications of up to 30% to 40% has been reported, and in such cases most patients require a second procedure. 2,5,[9][10][11][12] These complications lead to delayed post-operative chemotherapy and a poor oncological and functional outcome. 1,2,11,13 Possible reasons for the significantly high rate of complications after pelvic surgery include insufficient soft-tissue cover and a large dead space after wide excision.…”

Adductor Myocutaneous Flap Coverage for Hip and Pelvic Disarticulations of Sarcomas with Buttock Contamination

“…In one large case series, Senchenkov et al [18] reported flap necrosis of 13% (eight of 60 cases) for posterior flap closure and 37.5% (three of eight cases) for anterior flap closures. Wound infection, however, is reported to range from 17% to 46%, depending on the level of ligation of the iliac vessels [19]. We attribute good wound healing in our patients to the large muscle mass of the adductor compartment and its fairly abundant blood supply.…”

Extending the Indications for Primary Nerve Surgery in Obstetrical Brachial Plexus Palsy

“…Early operative management, consisting of nerve grafts and nerve transfers, has been accepted as the standard of care for total plexus injuries [11]. However there is no consensus regarding the indications for and timing of surgical management for subtotal obstetrical brachial plexus injuries.…”

“…If the child fails the Cookie Test operative management is recommended. In cases selected based on the surgeons' experience surgery may be recommended at 6 months of age if there has been little or no improvement since the 3-month visit and the probability of passing the Cookie Test if recovery was allowed until 9 months of age is deemed to be small [11]. …”