Soft Tissue Reconstruction Following Sacral Neoplasm Resection: The UCSF Experience
Jacquelyn A. Withers, B.S., Merisa Piper, M.D., Rachel Lentz, M.D., William Hoffman, M.D., Hani Sbitany, M.D..
University of California, San Francisco, San Francisco, CA, USA.
PURPOSE: Resection of sacral neoplasms and subsequent reconstruction of large soft tissue defects is a complex, multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning, however there is no consensus on how to maximize outcomes. We present our institution's experience treating this patient population.
METHODS: We performed a retrospective review of patients who underwent reconstruction following resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002-2016. Surgical details, hospital stay, postoperative complications and long-term outcomes were assessed.
RESULTS: Twenty-one patients (9 females, 12 males), mean age 61 (34-86), were reviewed. Mean postoperative follow-up was 43 months. Fifteen patients (71%) were reconstructed with gluteal-based flaps. The remaining had combinations of paraspinous, rectus abdominus, and locoregional fasciocutaneous flaps. Mesh was placed to reconstruct parasacral fascia in 17 patients (81%). Twelve patients (57%) had adjuvant or neoadjuvant radiotherapy. The overall early and late wound complication rates were 38% and 29% respectively. Patients with mesh placement were more likely to avoid early dehiscence (RR 1.4 CI 1.042 - 1.925), late wound infection (RR 1.3 CI 1.005 - 1.702), and reoperation for late wound complications (RR 1.4, 1.042 - 1.925). Neither history of prior abdominal surgery nor adjuvant/neoadjuvant radiation therapy increase risk of early or late wound complications.
CONCLUSION: Our preferred reconstruction of these defects involves mesh in conjunction with a muscle-based flap. In addition to providing durable support and coverage, mesh offered protection against early and late wound complications, a source of significant morbidity in this patient population.
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