Soft-tissue reconstruction after total en bloc sacrectomy.

摘要: OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide treatment algorithm to guide surgical care this unique patient population. METHODS After institutional review board approval, data were collected for all between 2002 2012 at Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, details, postoperative complications, outcomes. All subtotal sacrectomies excluded. RESULTS Between 2012, 9 with reconstruction. Diagnoses chordoma (n = 5), osteoblastoma 1), sarcoma 2), metastatic colon cancer 1). Six received gluteus maximus (GM) flaps prosthetic rectal sling following single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three multistage an anterior-posterior approach, 2 whom vertical rectus abdominis myocutaneous (VRAM) flaps, 1 local GM, LD, PSM Flap complications dehiscence 4) infection During the 1st year follow-up, (22%) able ambulate assistive device by month, 6 (67%) ambulatory walker 3rd month. By Month 12, 5 (56%)-or not lost follow-up (100%)-were independently. CONCLUSIONS authors' experience suggests GM VRAM are reliable options softtissue For posterior-only operations, without generally used. operations including laparotomy, consider be gold standard simultaneous pelvic diaphragm obliteration dead space.