Characterization of Soft Tissue Reconstruction Following Chordoma Resection

Chordomas are rare, malignant bone tumors of the axial skeleton. Soft tissue reconstruction is often needed postextirpation to reduce the risk of peritoneal content herniation. The purpose of this study is to describe presurgical factors associated with postchordoma resection reconstruction and evaluate postoperative outcomes.We retrospectively reviewed patients who underwent reconstruction postexcision of chordomas derived from the lumbar or sacral regions at a single institution between 2012 and 2023. Wilcoxon rank sum test, chi-square test, Fisher's exact test, and Kruskal-Wallis test were used to compare outcomes based on reconstruction method.Among 68 patients who met the inclusion criteria, 67 underwent sacrectomy. Patients primarily received gluteus muscle (GM) flaps (n = 36, 53%). Vertical rectus abdominus myocutaneous (VRAM) and paraspinous muscle (PSM) flaps were the second most common, each used in 12 patients (18%). Eight patients (12%) underwent reconstruction with fasciocutaneous local flaps only. GM and VRAM flaps were primarily used to reconstruct defects at the level of the sacrum (n = 47, 98%) while PSM flaps were used for lumbar (n = 7 [58%]) and sacral (n = 5 [42%]) reconstruction, respectively. The median tumor volumes were 468 cm³ (271-1,592) for VRAM flaps, 92 cm³ (12-246) for GM flaps, 77 cm³ (34-239) for PSM flaps, and 25 cm³ (16-86) for non-muscle reconstruction; tumor volume was significantly greater in patients who underwent VRAM flap reconstruction. Median defect diameter managed by VRAM flaps was significantly longer compared with GM flaps (33 [30-46] cm vs. 22 [15-30] cm, respectively; p = 0.001). VRAM and PSM flap reconstruction were more often associated with hardware placement (p < 0.01). Median follow-up was 34 months. Neither reconstruction type nor hardware placement was associated with the incidence of postoperative complications.We found that surgical reconstruction following chordoma resection varied depending on the chordoma spinal level, tumor volume, and defect diameter. Complication rates were similar among the included reconstructive options.