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Updated: Aug 8, 2026
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Experimental Strategies to Bridge Large Tissue Gaps in the Injured Spinal Cord after Acute and Chronic Lesion
Published on: April 5, 2016
Reconstruction of large sacral defects following total sacrectomy
W K Miles1, D W Chang, S S Kroll
1Department of Plastic and Reconstructive Surgery at the University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Plastic and Reconstructive Surgery
|June 14, 2000
Summary
Reconstructing large sacral defects after total sacrectomy requires careful consideration of flap options. Bilateral gluteal advancement flaps, transpelvic VRAM flaps, and free flaps are reliable choices based on patient history and vessel integrity.
Area of Science:
- Surgical Reconstruction
- Oncology
- Plastic Surgery
Background:
- Total sacrectomies for cancer ablation create extensive defects, posing significant reconstructive challenges.
- Effective reconstruction is crucial for patient recovery and functional outcomes following sacral defect creation.
Purpose of the Study:
- To review institutional experience in managing large sacral wound defects post-total sacrectomy.
- To elucidate criteria for selecting the most effective reconstructive options for these complex defects.
Main Methods:
- Retrospective review of 25 patients undergoing sacral defect reconstruction after total sacrectomy (1993-1998).
- Assessment of defect size, reconstruction type (VRAM, gluteal advancement, gluteal rotation, combined flaps, free flaps), complications, and functional outcomes.
- Analysis of diagnoses including chordoma, giant cell carcinoma, sarcoma, rectal adenocarcinoma, and radiation-induced necrosis.
Main Results:
- 27 flaps were performed for defects ranging from 18 to 450 cm² (mean 189.8 cm²).
- Bilateral gluteal advancement flaps (n=8) had no complications. Transpelvic VRAM flaps (n=10) had a 50% complication rate. Free flaps (n=3) had no complications.
- Gluteal rotation flaps and combined flaps showed higher complication rates, particularly in patients with prior radiation.
Conclusions:
- Bilateral gluteal advancement flaps are recommended for patients without prior radiation and intact gluteal vessels.
- Transpelvic VRAM flaps are suitable for patients with prior radiation or damaged gluteal vessels.
- Free flaps serve as a viable alternative when VRAM flaps are contraindicated, such as after abdominal surgery.
