The Superior Rectal Artery as a Recipient Vessel for Free Flap Transfer After Partial Sacrectomy in Patients With Chordoma

Abstract

Free flaps have rarely been used to reconstruct lumbosacral defects, primarily because of the lack of suitable recipient vessels in this region. We propose the novel use of the superior rectal artery as a recipient vessel for free flap transfer after partial or total sacrectomy. We transferred free flow-through latissimus dorsi musculocutaneous flaps, with the superior rectal vessels as recipient vessels, to reconstruct defects after partial sacrectomy in 2 patients with sacral chordoma. The flaps survived completely, and the wounds healed uneventfully in both patients. The superior rectal artery is easier to dissect and anastomose than are gluteal vessels and is less affected by patients' postoperative postural change than are extraperitoneal vessels. We believe that the superior rectal artery is a versatile recipient vessel for free flap transfer to reconstruct sacrectomy defects.

Free Flap Reconstruction of Oncologic Gluteal Defects

“…It was observed that free flaps can provide greater flap volume and greater freedom of flap placement than regional flaps, and they make the obliteration of dead space and tensionfree wound closure possible. 9 The flap that fits the defect in size and shape can be transferred, and the suture lines can be simplified without interference with donor site closure. We believe that these tages of free flaps can provide reliable wound coverage for oncologic gluteal defects.…”

“…15 With regard to the free flap donor site, the latissimus dorsi flap was determined to have several advantages, making it the flap of choice for gluteal reconstruction. 9,11,16 The main advantage is that the shape and volume of the flap can be easily tailored to meet the requirements of an individual defect. The second advantage is that the flaps can be harvested using a 2-team approach with the patient in either prone or lateral decubitus position, as the donor site is distant from the recipient site.…”

“…In addition, dehiscence of the gluteal wounds can easily spread to the donor site, and the resultant open wounds tend to be large. It was observed that free flaps can provide greater flap volume and greater freedom of flap placement than regional flaps, and they make the obliteration of dead space and tension-free wound closure possible 9 . The flap that fits the defect in size and shape can be transferred, and the suture lines can be simplified without interference with donor site closure.…”

“…With regard to the free flap donor site, the latissimus dorsi flap was determined to have several advantages, making it the flap of choice for gluteal reconstruction 9,11,16 . The main advantage is that the shape and volume of the flap can be easily tailored to meet the requirements of an individual defect.…”

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction

“…Free flaps can be an alternative option, allowing the use of distant flaps such as ALT or even latissimus dorsi. However, the increased surgical complexity and the challenge of finding recipient vessels in a previously irradiated wound site limit their use 38 . The 2 cases that required free flaps did not increase the mean operating time.…”