Microsurgical Reconstruction After Pelvic Tumor Resection

Summary

The pelvis is the largest bone in the body. Various bone tumors may originate in the pelvis. The abundant circulation to the pelvic bones may be responsible, in part, for disseminating various types of metastatic tumors. In their early stages, these tumors may grow into the pelvic cavity without being noticed. Radical resection of these tumors frequently produces large and complex bone and soft-tissue defects.

An external hemipelvectomy, which requires the removal of a healthy lower limb below the hip, is not always well accepted by patients. However, an internal hemipelvectomy has to be followed by procedures to reconstruct the pelvic ring and hip joint in order to achieve a reasonably active postoperative lifestyle for these patients. Reconstructions using an allograft or an autoclaved autogenous bone graft may cause numerous complications associated with the presence of these large devascularized tissues. This problem may be avoided, and early union and stable gait may be achieved, by rebuilding the pelvic ring using microsurgical reconstruction with sections of dual or double-barreled free fibula. Filling a large defect with well-vascularized tissue and covering the defect with stable skin are crucial for the treatment of difficult infected wounds. A vascularized latissimus dorsi myocutaneous flap transfer with long vein grafts may serve as a useful tool in such difficult situations.