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Soft-tissue reconstruction after total en bloc sacrectomy.
J Neurosurg Spine. 2015 Jun; 22(6):571-81.JN

Abstract

OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population.

METHODS

After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded.

RESULTS

Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)-or 5 of 5 patients not lost to follow-up (100%)-were able to able to ambulate independently.

CONCLUSIONS

The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

Authors+Show Affiliations

Departments of 1Plastic and Reconstructive Surgery and. 2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.Departments of 1Plastic and Reconstructive Surgery and.Departments of 1Plastic and Reconstructive Surgery and.Departments of 1Plastic and Reconstructive Surgery and.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.2Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.Departments of 1Plastic and Reconstructive Surgery and.Departments of 1Plastic and Reconstructive Surgery and.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25815806

Citation

Kim, Jennifer E., et al. "Soft-tissue Reconstruction After Total En Bloc Sacrectomy." Journal of Neurosurgery. Spine, vol. 22, no. 6, 2015, pp. 571-81.
Kim JE, Pang J, Christensen JM, et al. Soft-tissue reconstruction after total en bloc sacrectomy. J Neurosurg Spine. 2015;22(6):571-81.
Kim, J. E., Pang, J., Christensen, J. M., Coon, D., Zadnik, P. L., Wolinsky, J. P., Gokaslan, Z. L., Bydon, A., Sciubba, D. M., Witham, T., Redett, R. J., & Sacks, J. M. (2015). Soft-tissue reconstruction after total en bloc sacrectomy. Journal of Neurosurgery. Spine, 22(6), 571-81. https://doi.org/10.3171/2014.10.SPINE14114
Kim JE, et al. Soft-tissue Reconstruction After Total En Bloc Sacrectomy. J Neurosurg Spine. 2015;22(6):571-81. PubMed PMID: 25815806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Soft-tissue reconstruction after total en bloc sacrectomy. AU - Kim,Jennifer E, AU - Pang,John, AU - Christensen,Joani M, AU - Coon,Devin, AU - Zadnik,Patricia L, AU - Wolinsky,Jean-Paul, AU - Gokaslan,Ziya L, AU - Bydon,Ali, AU - Sciubba,Daniel M, AU - Witham,Timothy, AU - Redett,Richard J, AU - Sacks,Justin M, Y1 - 2015/03/27/ PY - 2015/3/28/entrez PY - 2015/3/31/pubmed PY - 2015/8/15/medline KW - AP = anterior-posterior KW - BMI = body mass index KW - DM = diabetes mellitus KW - EBL = estimated blood loss KW - GM = gluteus maximus KW - LD = latissimus dorsi KW - LOS = length of hospital stay KW - PSM = paraspinous muscle KW - RT = radiation therapy KW - VAC = vacuum-assisted closure KW - VRAM KW - VRAM = vertical rectus abdominis myocutaneous KW - plastic surgery KW - sacral tumor KW - sacrectomy KW - soft tissue defect KW - spine surgery SP - 571 EP - 81 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 22 IS - 6 N2 - OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)-or 5 of 5 patients not lost to follow-up (100%)-were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/25815806/Soft_tissue_reconstruction_after_total_en_bloc_sacrectomy_ L2 - https://thejns.org/doi/10.3171/2014.10.SPINE14114 DB - PRIME DP - Unbound Medicine ER -