Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases.
BACKGROUND
Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity.


METHODS
The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis.


RESULTS
There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy.


CONCLUSIONS
External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.
Senchenkov
Alex
A
Division of Plastic & Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. senchenkov@yahoo.com
Moran
Steven L
SL
Petty
Paul M
PM
Knoetgen
James
J
Clay
Ricky P
RP
Bite
Uldis
U
Barnes
Sunni A
SA
Sim
Franklin H
FH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006428:Hemipelvectomy / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D012307:Risk Factors; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate