Jill P Stone1, Mieke Heyns2, Rebecca Hartley1, Marcio Barreto3 and Claire Temple-Oberle1,3*
1Division of Plastic Surgery, Department of Surgery, University of Calgary, Canada
2University of Calgary, Canada
3Division of Surgical Oncology, Department of Surgery, University of Calgary, Canada
Introduction: Enbloc tumor resection of the sacrum can leave the posterior pelvis devoid of structural support and soft tissue coverage, putting patients at risk of postoperative complications and sacral herniation. Compared to total sacrectomies, partial sacrectomy defects can often be managed without instrumentation to reconstruct the structural support of the spino-pelvic junction. However, lack of skeletal support and often large soft tissue defects lead to challenges in decisionmaking for posterior pelvic reconstruction (PPR).Objective: The objective of this paper is to share a reconstructive method for posterior pelvic reconstruction following a partial sacrectomy and present a systematic review of the current literature.Material and
Methods: A systematic review identified relevant studies published through Medline Ovid until July 2015. Search terms focused on (1) Reconstruction (2) Primary sacral tumors. Data collection included the following: (1) Patient demographics (2) Sacral resection (3) Reconstruction of defect (4) Tumor pathology (5) Patient outcome - complications and follow-up.Result: A total of twenty-three articles highlight soft-tissue reconstruction in posterior sacral defects following partial sacrectomies. Fifty-nine patients met our inclusion criteria. Age ranged from 23 – 71 years old. There were 28 male and 28 female (3 unknown sex) patients. The most common pathology was chordoma (n=49, 83%). Other pathology included giant cell tumor, myxopapillary ependymoma, and chondrosarcoma. Follow-up time ranged from 6-96 months. Eighteen articles highlighted the use of soft tissue flaps. Gluteal-based and vertical rectus flaps were most common. Other closures included omental, paraspinous, gluteal thigh and free latissimus flaps. Five articles showcased the use of synthetic mesh materials and 31 patients had acellular dermal matrix in their reconstruction. Complications included infection, deep vein thrombosis, flap necrosis, wound dehiscence, seroma and rectal perforation secondary to mesh.Discussion: Partial sacrectomy reconstruction is varied in its approach. Few published case reports and series are available to guide the reconstructive surgeon.
Stone JP, Heyns M, Hartley R, Barreto M, Temple-Oberle C. Posterior Pelvic Reconstruction: A Case and Review of the Literature. Clin Surg. 2016; 1: 1147.