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Reconstruction after internal hemipelvectomy: outcomes and reconstructive algorithm.

Albert H Chao1, Sara A Neimanis, David W Chang

  • 1From the Departments of *Plastic Surgery and †Orthopedic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.

Annals of Plastic Surgery
|August 2, 2013
PubMed
Summary
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Reconstruction after internal hemipelvectomy for pelvic tumors reduces late complications without impacting survival or function. This study found fewer late issues in reconstructed patients, suggesting reconstruction is beneficial.

Area of Science:

  • Orthopedic oncology
  • Surgical reconstruction
  • Pelvic tumor treatment

Background:

  • Internal hemipelvectomy is a preferred surgical approach for select pelvic and lower extremity tumors.
  • Extensive resections can lead to significant bony and soft tissue deficits.
  • The benefit-risk ratio of reconstruction after internal hemipelvectomy remains unclear.

Purpose of the Study:

  • To evaluate the effect of reconstruction on surgical complications, postoperative function, and survival following internal hemipelvectomy.
  • To compare outcomes between patients who underwent reconstruction and those who did not.

Main Methods:

  • Retrospective review of 111 patients who underwent internal hemipelvectomy between 1998 and 2011.
  • Comparison of outcomes (complications, function, survival) between 51 reconstructed patients and 60 non-reconstructed patients.

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  • Reconstruction methods included mesh, soft tissue flaps, and vascularized bone flaps.

    • Main Results:

    • Overall early complication rates were similar between groups (15.7% reconstruction vs. 23.3% no reconstruction; P=0.35).
    • Late recipient-site complications were significantly lower in the reconstruction group (7.8% vs. 26.7%; P=0.01).
    • Musculoskeletal Tumor Society scores were higher in the reconstruction group (62.8% vs. 48.4%; P=0.12), though not statistically significant.

    Conclusions:

    • Immediate reconstruction of internal hemipelvectomy defects significantly reduces late recipient-site complications.
    • Reconstruction does not adversely affect perioperative course or overall survival rates.
    • An algorithm for reconstruction based on these outcomes is presented.