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Flap reconstruction for sacrectomy defects: A systematic review and meta-analysis
Malke Asaad1, Aashish Rajesh2, Waseem Wahood3
1Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|November 24, 2019
Summary
Plastic surgeons reconstruct sacral defects using gluteal-based and vertical rectus abdominis myocutaneous (VRAM) flaps. Both flap types have high complication rates, but total flap loss is rare, allowing for good functional outcomes.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oncology
Background:
- Sacral tumor excision often results in large soft tissue defects.
- Flap coverage is essential for wound healing and obliterating dead space after sacrectomy.
- Evaluating outcomes of soft tissue reconstruction following sacrectomy is crucial.
Purpose of the Study:
- To evaluate the outcomes and complications of soft tissue reconstruction for sacrectomy defects.
- To compare the effectiveness of different flap types in sacral defect reconstruction.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive database search from 1950 to 2019 for relevant studies.
- Abstraction and analysis of demographics, surgical characteristics, and complication rates.
Main Results:
- Gluteal-based flaps (50%) and vertical rectus abdominis myocutaneous (VRAM) flaps (38%) are most common.
- High sacrectomy and preoperative radiation correlate with significantly higher local complication rates.
- Pooled local complication rates were 37% for gluteal flaps and 50% for VRAM flaps; total flap loss was rare.
Conclusions:
- Gluteal-based and VRAM flaps are primary choices for sacral reconstruction.
- These reconstructions have high complication rates, but total flap loss is infrequent.
- Good functional outcomes are achievable following sacrectomy reconstruction.
