Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection

Yao, Weitao; Cai, Qianqian; Songtao, G.; Wang, Jiaqiang

doi:10.1186/1477-7819-11-110

Cited by 9 publications

(10 citation statements)

References 21 publications

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“…While locoregional flaps are the standard of care in most sacral wound defects, they are not plausible in many scenarios. Numerous local flap options have been reported, including gluteal artery perforator flaps (13–16), gluteus maximus sliding flaps (17), paraspinal flaps (18), V-Y advancement flaps (19, 20), and regional anterolateral thigh flaps (21). However, they are relatively contraindicated in oncological sacral defects.…”

Section: Discussionmentioning

confidence: 99%

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

García-Tutor¹,

Romeo²,

Chae³

et al. 2016

Front. Surg.

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BackgroundLocoregional flaps are sufficient in most sacral reconstructions. However, large sacral defects due to malignancy necessitate a different reconstructive approach, with local flaps compromised by radiation and regional flaps inadequate for broad surface areas or substantial volume obliteration. In this report, we present our experience using free muscle transfer for volumetric reconstruction, in such cases, and demonstrate three-dimensional (3D) haptic models of the sacral defect to aid preoperative planning.MethodsFive consecutive patients with irradiated sacral defects secondary to oncologic resections were included, surface area ranging from 143–600 cm2. Latissimus dorsi (LD)-based free flap sacral reconstruction was performed in each case, between 2005 and 2011. Where the superior gluteal artery was compromised, the subcostal artery (SA) was used as a recipient vessel. Microvascular technique, complications, and outcomes are reported. The use of volumetric analysis and 3D printing is also demonstrated, with imaging data converted to 3D images suitable for 3D printing with Osirix software (Pixmeo, Geneva, Switzerland). An office-based, desktop 3D printer was used to print 3D models of sacral defects, used to demonstrate surface area and contour and produce a volumetric print of the dead space needed for flap obliteration.ResultsThe clinical series of LD free flap reconstructions is presented, with successful transfer in all cases, and adequate soft-tissue cover and volume obliteration achieved. The original use of the SA as a recipient vessel was successfully achieved. All wounds healed uneventfully. 3D printing is also demonstrated as a useful tool for 3D evaluation of volume and dead space.ConclusionFree flaps offer unique benefits in sacral reconstruction where local tissue is compromised by irradiation and tumor recurrence, and dead space requires accurate volumetric reconstruction. We describe for the first time the use of the SA as a recipient in free flap sacral reconstruction. 3D printing of haptic bio-models is a rapidly evolving field with a substantial role in preoperative planning.

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Section: Discussionmentioning

confidence: 99%

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

García-Tutor¹,

Romeo²,

Chae³

et al. 2016

Front. Surg.

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“…The extensive resection of sacral tumors is always associated with large defects or dead-space cavities, and to optimize surgical wound outcome, minimizing the risk of wound dehiscence or infection, their intervention is crucial [44–48]. We adopted the closure technique described by Yao et al [49]. This technique has many advantages over other reconstruction and closure approaches: it keeps a native and robust blood supply of the flaps, creates a protective tissue layer while also absorbing cavity effusion, and reduces seroma formation, wound dehiscence, and rate of infection, which can reach as much as 38% [49].…”

Section: Discussionmentioning

confidence: 99%

“…We adopted the closure technique described by Yao et al [49]. This technique has many advantages over other reconstruction and closure approaches: it keeps a native and robust blood supply of the flaps, creates a protective tissue layer while also absorbing cavity effusion, and reduces seroma formation, wound dehiscence, and rate of infection, which can reach as much as 38% [49]. …”

Section: Discussionmentioning

confidence: 99%

Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy forEn BlocExcision of Sacral Giant Cell Tumors

Gonçalves

Lima

Gíria³

et al. 2014

Case Reports in Surgery

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Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.

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“…The aim of this study is to present a group of patients with large defects that were reconstructed using a single SGAP flap. Novel techniques that are introduced are (1) reconstruction of large defects using a single unilateral flap that is smaller than the defect itself, thus preserving maximal tissue with less incision; (2) no intramuscular perforator dissection or pedicle skeletonization, thus increasing safety; (3) using only 45°to 60°transposition, thus preventing possible kinking of the pedicle.…”

mentioning

confidence: 99%

“…Midline sacral defects are common after pressure sore, hidradenitis suppurativa, pilonidal sinus, and malignancies. Although small defects can be reconstructed with small local flaps or even with secondary healing, large defects require more complex reconstructions 1–6 . Superior gluteal artery perforator (SGAP) flap provides adequate tissue as well as versatility in design and size to cover such defects, while preserving muscles and decreasing donor site morbidity 3,7–11 .…”

mentioning

confidence: 99%

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

et al. 2022

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Background: Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. Methods: Large sacral defects (>100 cm 2 ) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. Results: There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm 2 , between 9 Â 8 and 26 Â 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm 2 , between 10 Â 10 and 28 Â 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. Conclusion: Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°.

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Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection

Cited by 9 publications

References 21 publications

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy forEn BlocExcision of Sacral Giant Cell Tumors

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects

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