Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine

Unal, Cigdem; Eren, Guler Gamze; Işıl, Eda; Alponat, Ahmet; Şarlak, Ahmet Yılmaz

doi:10.4103/0970-0358.96617

Cited by 3 publications

(2 citation statements)

References 10 publications

(20 reference statements)

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“…Other methods have involved meshes [12], omental mobilization [13] and free flaps [14]; however, some of these methods have been associated with additional injuries to patients and/or dangerous complications, such as necrosis [15]. We performed a retrospective study to assess whether reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve outcomes after sacral tumor excision.…”

Section: Introductionmentioning

confidence: 99%

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

Yao¹,

Cai²,

Songtao³

et al. 2013

World J Surg Onc

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BackgroundWhile performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes.MethodsBetween February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2).ResultsWe assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17–43 days) vs. 16.82 days (range 13–21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000–4,000 mL) vs. 1,733 mL (range 1,500–2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05).ConclusionsThe use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.

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Section: Introductionmentioning

confidence: 99%

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

Yao¹,

Cai²,

Songtao³

et al. 2013

World J Surg Onc

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“…Less discussion of free flaps for sacral reconstruction exist, with interpolation flaps utilizing omentum (22), the vertical rectus abdominis myocutaneous flap (23–25), the LD flaps, the chimeric LD flaps combined with the serratus anterior, and the free fibula flap all used in this setting (26, 27). Consistent with previous authors’ choice, the LD flap is reliable, easier, faster, and associated with less morbidities than many of the other options.…”

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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Management of spinal giant cell tumors

et al. 2016

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Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine

Cited by 3 publications

References 10 publications

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

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

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

Management of spinal giant cell tumors

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