Adductor myocutaneous flap coverage for hip and pelvic disarticulations of sarcomas with buttock contamination.
BACKGROUND
Hip disarticulation and hemipelvectomy are alternatives to limb-salvage procedures for patients with extensive tumors of the upper thigh and buttocks. In cases when neither the conventional posterior gluteus maximus flap nor the anterior quadriceps flap can be used because of the location of the tumor, a medial adductor myocutaneous flap may be an alternative.


METHODS
The flap is outlined over the anteromedial thigh. The distal extent is at the level of the adductor hiatus. The common femoral vessels and nerve are traced, preserved, and protected. The adductor muscles then are divided above their insertions on the femur and preserved with the flap. En bloc removal of the tumor is performed by either hip disarticulation or hemipelvectomy. The long adductor myocutaneous flap is brought up laterally and proximally to close the wound.


METHODS
We reviewed four patients who underwent a medial adductor myocutaneous flap after either hip disarticulation or hemipelvectomy. The medical records and radiographs were analyzed. These patients were followed up for at least a year or until death.


RESULTS
Wide surgical margins were achieved in all four patients and the flap remained viable, with no skin necrosis or flap breakdown. The patients were able to sit on the flap, and one patient was able to wear a prosthesis.


CONCLUSIONS
In patients undergoing hip disarticulation or hemipelvectomy where tumor infiltration or inadvertent contamination by previous surgery will not allow the traditional posterior gluteus maximus or anterior quadriceps flap, this unconventional medial adductor myocutaneous flap is a feasible, technically simple option.


METHODS
Level IV therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Marfori
Michael L
ML
Department of Orthopaedics, De La Salle University Health Sciences Institute, Gov D Mangubat Avenue, Dasmariñas City 4114, The Philippines. micomarfori_md@yahoo.com.ph
Wang
Edward H M
EH
D000328:Adult; D001186:Artificial Limbs; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002081:Buttocks; D004188:Disarticulation; D005260:Female; D005266:Femoral Neoplasms / Q000473:pathology / Q000601:surgery; D006621:Hip Joint / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery; D010679:Philippines; D052097:Quadriceps Muscle / Q000473:pathology / Q000601:surgery*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013977:Tibia / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome