Reconstruction of the pelvic ring with vascularized double-strut fibular flap following internal hemipelvectomy.
BACKGROUND
After internal hemipelvectomy, successful pelvic reconstruction can provide a durable and pain-free reconstruction for the young, active patient. Such reconstruction is extremely challenging, and often patients have less than optimal ambulation with a limp, leg length discrepancy, or leg instability. The authors present an innovative method for pelvic ring reconstruction using a vascularized double-strut fibular bone flap that provides a stable pelvis and recovery of normal or near-normal gait.


METHODS
From December of 2003 to November of 2005, six sarcoma patients underwent internal hemipelvectomy and pelvic ring reconstruction with a vascularized double-strut fibular bone flap. The length of each strut was 7 to 12 cm.


RESULTS
All bone flaps survived. The mean follow-up was 18 months (range, 8 to 32 months). Radiographic evidence of bone bridging was seen at a mean of 2.5 months (range, 2 to 4 months). The mean time to ambulation without assistance was 8 months (range, 5 to 18 months). One patient died as a result of metastatic disease. The remaining five patients are ambulatory with a mild limp or no limp.


CONCLUSIONS
Use of a vascularized double-strut fibular bone flap for pelvic ring reconstruction is effective in facilitating early ambulation and restoring normal to near-normal gait in patients undergoing internal hemipelvectomy.
Houston, Texas From the Departments of Plastic Surgery and Surgical Oncology, University of Texas M. D. Anderson Cancer Center.
David W
DW
Chang
Amanda J
AJ
Fortin
Scott D
SD
Oates
Valerae O
VO
Lewis
D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006085:Graft Survival; D006428:Hemipelvectomy / Q000379:methods; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery*; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome