Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection

Yao Weitao, Cai Qiqing, Gao Songtao, Wang Jiaqiang, Yao Weitao, Cai Qiqing, Gao Songtao, Wang Jiaqiang

Abstract

Background: While performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes.

Methods: Between February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2).

Results: We assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17-43 days) vs. 16.82 days (range 13-21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000-4,000 mL) vs. 1,733 mL (range 1,500-2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05).

Conclusions: The use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.

Figures

Figure 1
Figure 1
Reconstruction of the sacral defect caused by tumor resection with bilateral gluteus maximus (GLM) adipomuscular sliding flaps. A huge defect is left after sacral tumor resection (a). Separation of the GLM adipomuscular flap on one side (b). Separation of another side of the GLM adipomuscular flap (c). The defect is eliminated by advancement of the bilateral GLM adipomuscular flaps (d).
Figure 2
Figure 2
Magnetic resonance imaging of the tumor and flap. Sacral tumor and intact gluteus maximus (GLM) (arrow) before surgery (a). Well-maintained GLM adipomuscular flap (arrow) behind the rectum (b) 6 months after surgery.

References

    1. Balke M, Henrichs MP, Gosheger G, Ahrens H, Streitbuerger A, Koehler M, Bullmann V, Hardes J. Giant cell tumors of the axial skeleton. Sarcoma. 2012;11:410973.
    1. Donati D, Frisoni T, Dozza B, DeGroot H, Albisinni U, Giannini S. Advance in the treatment of aneurysmal bone cyst of the sacrum. Skeletal Radiol. 2011;11:1461–1466. doi: 10.1007/s00256-011-1202-7.
    1. Syed R, Bishop JA, Ali SZ. Sacral and presacral lesions: cytopathologic analysis and clinical correlates. Diagn Cytopathol. 2012;11:7–13. doi: 10.1002/dc.21480.
    1. Ferraresi V, Nuzzo C, Zoccali C, Marandino F, Vidiri A, Salducca N, Zeuli M, Giannarelli D, Cognetti F, Biagini R. Chordoma: clinical characteristics, management and prognosis of a case series of 25 patients. BMC Cancer. 2010;11:22. doi: 10.1186/1471-2407-10-22.
    1. Lee J, Bhatia NN, Hoang BH, Ziogas A, Zell JA. Analysis of prognostic factors for patients with chordoma with use of the California Cancer Registry. J Bone Joint Surg Am. 2012;11:356–363. doi: 10.2106/JBJS.J.01784.
    1. Quraishi NA, Giannoulis KE, Edwards KL, Boszczyk BM. Management of metastatic sacral tumours. Eur Spine J. 2012;11:1984–1993. doi: 10.1007/s00586-012-2394-9.
    1. Clarke MJ, Dasenbrock H, Bydon A, Sciubba DM, McGirt MJ, Hsieh PC, Yassari R, Gokaslan ZL, Wolinsky JP. Posterior-only approach for en bloc sacrectomy: clinical outcomes in 36 consecutive patients. Neurosurgery. 2012;11:357–364. doi: 10.1227/NEU.0b013e31825d01d4.
    1. Garvey PB, Rhines LD, Feng L, Gu X, Butler CE. Reconstructive strategies for partial sacrectomy defects based on surgical outcomes. Plast Reconstr Surg. 2011;11:190–199. doi: 10.1097/PRS.0b013e3181f95a19.
    1. Ruggieri P, Angelini A, Pala E, Mercuri M. Infections in surgery of primary tumors of the sacrum. Spine (Phila Pa 1976) 2012;11:420–428. 1.
    1. Asavamongkolkul A, Waikakul S. Wide resection of sacral chordoma via a posterior approach. Int Orthop. 2012;11:607–612. doi: 10.1007/s00264-011-1381-9.
    1. Horch RE, D'Hoore A, Holm T, Kneser U, Hohenberger W, Arkudas A. Laparoscopic abdominoperineal resection with open posterior cylindrical excision and primary transpelvic VRAM flap. Ann Surg Oncol. 2012;11:502–503. doi: 10.1245/s10434-011-1977-8.
    1. Dasenbrock HH, Clarke MJ, Bydon A, Witham TF, Sciubba DM, Simmons OP, Gokaslan ZL, Wolinsky JP. Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps. Neurosurgery. 2011;11:1240–1247. doi: 10.1227/NEU.0b013e3182267a92.
    1. Unal C, Eren GG, Isil E, Alponat A, Sarlak A. Utility of the omentum in sacral reconstruction following total sacrectomy due to recurrent and irradiated giant cell tumour of the spine. Indian J Plast Surg. 2012;11:140–143. doi: 10.4103/0970-0358.96617.
    1. Stechl NM, Baumeister S, Grimm K, Kraus TW, Bockhorn H, Exner KE. Microsurgical reconstruction of the pelvic floor after pelvic exenteration. Reduced morbidity and improved quality of life by an interdisciplinary concept. Chirurg. 2011;11:625–630. doi: 10.1007/s00104-010-2022-3.
    1. Diaz J, McDonald WS, Armstrong M, Eismont F, Hellinger M, Thaller S. Reconstruction after extirpation of sacral malignancies. Ann Plast Surg. 2003;11:126–129. doi: 10.1097/01.SAP.0000063754.39566.5C.
    1. Glatt BS, Disa JJ, Mehrara BJ, Pusic AL, Boland P, Cordeiro PG. Reconstruction of extensive partial or total sacrectomy defects with a transabdominal vertical rectus abdominis myocutaneous flap. Ann Plast Surg. 2006;11:526–531. doi: 10.1097/01.sap.0000205772.15061.39.
    1. Daigeler A, Simidjiiska-Belyaeva M, Drücke D, Goertz O, Hirsch T, Soimaru C, Lehnhardt M, Steinau HU. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbecks Arch Surg. 2011;11:1271–1279. doi: 10.1007/s00423-011-0823-6.
    1. Park S. Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions. Plast Reconstr Surg. 2000;11:81–86. doi: 10.1097/00006534-200007000-00015.
    1. Vogt PM, Kall S, Lahoda LU, Spies M, Muehlberger T. The free "mutton chop" flap: a fascio-musculocutaneous flap for the reconstruction of the entire sacral and perineal area. Plast Reconstr Surg. 2004;11:1220–1224.
    1. Koh PK, Tan BK, Hong SW, Tan MH, Tay AG, Song C, Tan KC. The gluteus maximus muscle flap for reconstruction of sacral chordoma defects. Ann Plast Surg. 2004;11:44–49. doi: 10.1097/01.sap.0000106423.87203.a3.
    1. Haapamäki MM, Pihlgren V, Lundberg O, Sandzén B, Rutegård J. Physical performance and quality of life after extended abdominoperineal excision of rectum and reconstruction of the pelvic floor with gluteus maximus flap. Dis Colon Rectum. 2011;11:101–106. doi: 10.1007/DCR.0b013e3181fce26e.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever