title: Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps.
abstract: BACKGROUND
  Performing a sacrectomy from an exclusively posterior approach allows the en bloc resection of tumors without the morbidity of a laparotomy. However, reconstruction of the resultant extensive soft-tissue defects is challenging because a vertical rectus abdominis myocutaneous flap is not harvested.
  
  
  OBJECTIVE
  To report the largest series (with the longest follow-up) of sacral reconstructions using a combination of human acellular dermal matrix (HADM) and gluteus maximus myocutaneous flaps.
  
  
  METHODS
  Thirty-four patients with sacral tumors with a follow-up of at least 1 year were reviewed retrospectively. After the tumor was excised, HADM (AlloDerm, LifeCell Corp, Branchburg, New Jersey) was secured to create a pelvic diaphragm. Subsequently, the gluteus maximus muscles were freed from their origins and advanced to cover the HADM.
  
  
  RESULTS
  The mean age of patients was 50.1 years (SD, 16.0 years), and the histopathology was a chordoma in 82.4%. Seven patients (20.6%) developed a postoperative wound dehiscence, 5 of whom (14.7%) required operative debridement. An estimated blood loss of >1500 mL, an operative time of >9 hours during sacrectomy, and postoperative bowel incontinence were associated with a significantly higher likelihood of undergoing a subsequent debridement for dehiscence (P ≤ .03). With a mean follow-up of 45.7 months, only 1 patient developed an asymptomatic parasacral hernia.
  
  
  CONCLUSIONS
  Reconstruction of posterior sacrectomy defects with HADM and gluteus maximus myocutaneous flaps may be valid. This approach may have rates of wound dehiscence comparable to other techniques and low rates of parasacral herniation.
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA.
authors.forename: Hormuzdiyar H
authors.initials: HH
authors.lastname: Dasenbrock
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Simmons
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D002648:Child; D002817:Chordoma / Q000473:pathology / Q000601:surgery*; D003094:Collagen; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D017773:Pelvic Floor / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D003094:Collagen