The total thigh and rectus abdominis myocutaneous flap for closure of extensive hemipelvectomy defects

Abstract

Hemipelvectomy is a lifesaving procedure when used appropriately and yields a 35%, five‐year survival in the cancer patient. However, the standard posterior flap for closure is not always available. Two flaps, the thigh flap and the rectus abdominis myocutaneous flap, are described in which any soft tissue defect resulting from hemipelvectomy can be safely closed primarily when the posterior flap is not available. The total rectus abdominis flap is previously undescribed and unique in its application. These techniques significantly contribute to the surgeon's armamentarium for decreasing morbidity and mortality and resectability of unusual pelvic and thigh tumors.

Soft-Tissue Reconstruction of External Hemipelvectomy Defects

“…A fillet flap using the majority of the thigh musculature can be designed as a variation of the anterior hemipelvectomy flap. 19 The anterior hemipelvectomy flap is an axial pattern flap based on the common and superficial femoral arteries and branches of the profunda femoris complex such as the lateral circumflex artery that provide a vigorous blood supply. 10,20 The skin of the anterior thigh to the level of the knee is innervated by the lateral and anterior femoral cutaneous nerves.…”

Pelvic Resections

“…The advantages of the fl ap are its abundant supply of well-vascularized tissue, reliability, versatility, and the simplicity of dissection. [100][101][102] Some authors reported the use of the opposite fl ap to reduce complications. 98 In patients with anterior abdominal ostomies, this fl ap is often unavailable.…”

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

“…Unconventional closure techniques include island pedicle flaps, such as that of the ipsilateral rectus abdominis muscle, pedicled on the inferior epigastric vessels and mobilized and tunneled through a narrow abdominal skin bridge [9,16,22]. Another pedicled flap is that of the external oblique muscle, receiving its blood supply from the last six intercostal arteries, which can be rotated inferiorly to cover the defect [3].…”

“…Another pedicled flap is that of the external oblique muscle, receiving its blood supply from the last six intercostal arteries, which can be rotated inferiorly to cover the defect [3]. These relatively tedious surgeries, however, are accompanied by complications, such as serous leaks, hematoma, abscess formation, and flap failure [9,16,22], and sometimes also require the need for split thickness skin grafting of the donor site and increased operative time.…”

“…Wound closure, however, presents a problem when tumor involvement of the buttocks and anterior proximal thigh compartment precludes the use of the standard posterior gluteus maximus flap or even the atypical anterior quadriceps muscle flap [5,7,8,10,11,13,20,21,24]. Free flaps [2, 4, 15-17, 22, 23, 25, 26] (eg, latissimus dorsi muscle, fillet leg flap), pedicled flaps from the ipsilateral lower extremity [1], and regional flaps from the abdominal wall [3,16,22] (eg, rectus abdominis and external oblique muscles) are options, but they are associated with technical difficulties and donorsite morbidities.…”