title: Soft-tissue reconstruction of external hemipelvectomy defects.
abstract: BACKGROUND
  External hemipelvectomy is the ultimate salvage procedure for locally advanced pelvic tumors, infections, and failed revascularizations. It is associated with high wound morbidity requiring surgical management. In this study, the authors analyzed their experience with primary and secondary reconstruction of hemipelvectomy wounds.
  
  
  METHODS
  The records of 160 consecutive hemipelvectomy patients from the authors' institution were reviewed to identify the incidence of soft-tissue coverage problems and approaches to their management.
  
  
  RESULTS
  At the time of hemipelvectomy, a musculocutaneous hemipelvectomy flap was sufficient for closure in 159 patients, one patient needed a free lower leg fillet flap, and none required pedicle flaps. No hemipelvectomy hernias were observed, although abdominal wall reconstruction was performed in three patients. Wound complications were encountered in 62 patients (39 percent), and 51 patients required operative débridement. Thirty-three patients healed by secondary intention, and 25 underwent delayed reconstruction with local tissue rearrangements (n = 15), split-thickness skin grafting (n = 6), and pedicled flaps (n = 6). All pedicled flaps were contralateral inferiorly based rectus abdominis muscle (n = 2) and musculocutaneous (n = 4) flaps.
  
  
  CONCLUSIONS
  Hemipelvectomy is associated with high wound morbidity. When the hemipelvectomy flap has a musculocutaneous design, hernias are exceedingly rare. Although immediate reconstruction is accomplished with a hemipelvectomy flap in the vast majority of cases, secondary reconstructions are often required for management of wound complications. For large defects, a contralateral inferiorly based rectus abdominis muscle or musculocutaneous flap is the reconstruction of choice. The rectus abdominis muscle should therefore always be preserved in hemipelvectomy patients by careful preoperative planning, especially when creation of an ostomy is considered.
authors: Rochester, Minn. From the Division of Plastic and Reconstructive Surgery, the Department of Orthopedics, and the Division of Biostatistics, Mayo Clinic.
authors: Alex
authors: A
authors: Senchenkov
authors: Steven L
authors: SL
authors: Moran
authors: Paul M
authors: PM
authors: Petty
authors: James
authors: J
authors: Knoetgen
authors: Nho V
authors: NV
authors: Tran
authors: Ricky P
authors: RP
authors: Clay
authors: Uldis
authors: U
authors: Bite
authors: Craig H
authors: CH
authors: Johnson
authors: Sunni A
authors: SA
authors: Barnes
authors: Franklin H
authors: FH
authors: Sim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006428:Hemipelvectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult