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Updated: Jun 14, 2025
Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler
Published on: January 25, 2010
Reconstruction of Internal Hemipelvectomy Defects After Oncologic Resection
Max Vaynrub1, John H Healey, Carol D Morris
1From the Department of Surgery, Orthopaedic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY (Vaynrub, Healey, and Morris), Department of Surgery, Plastic & Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY (Shahzad).
Internal hemipelvectomy offers a functional limb preservation option over hindquarter amputation for pelvic tumors. Advanced reconstruction techniques in orthopaedic and plastic surgery enable successful outcomes by restoring skeletal and soft-tissue integrity.
Area of Science:
- Orthopaedic Surgery
- Surgical Oncology
- Reconstructive Surgery
Background:
- Internal hemipelvectomy is a preferred surgical approach for pelvic tumor resection over hindquarter amputation.
- This preference is contingent on achieving a functional lower extremity without compromising oncologic outcomes.
- Advances in reconstructive surgery have made limb preservation feasible.
Purpose of the Study:
- To outline the reconstructive goals and strategies for internal hemipelvectomy.
- To categorize pelvic resections and their specific reconstruction challenges.
- To highlight the multidisciplinary approach required for complex pelvic tumor resections.
Main Methods:
- Classification of pelvic resections into four types (I-IV) based on anatomical location (ilium, acetabulum, ischiopubic rami, sacrum).
- Description of reconstructive techniques for skeletal continuity (e.g., vascularized bone flaps, instrumentation, hip transposition, allografts, prosthetics).
- Emphasis on soft-tissue reconstruction for coverage and dead space elimination.
Main Results:
- Type I and IV resections often require vascularized bone flaps and instrumentation for pelvic discontinuity.
- Type II resections, associated with significant morbidity, utilize hip transposition, allografts, and prosthetic composites.
- Type III resections primarily need soft-tissue repair, while sacral involvement (Type IV) demands robust reconstructive strategies for stability and coverage.
Conclusions:
- Internal hemipelvectomy, when oncologically sound, allows for limb salvage and functional restoration.
- Multidisciplinary collaboration is crucial for managing complex pelvic resections and achieving optimal patient outcomes.
- Advanced reconstruction techniques are essential for addressing the deficits created by internal hemipelvectomy, minimizing complications, and maximizing function.
