Reconstruction of the pelvis and lumbar-pelvic junction using 2 vascularized autologous bone grafts after en bloc resection for an iliosacral chondrosarcoma

Technical note

View More View Less
  • 1 Departments of Neurologic Surgery,
  • 2 Orthopedic Surgery,
  • 3 Surgery, and
  • 4 Plastic Surgery, The Ohio State University Medical Center, Columbus, Ohio
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Primary pelvic sarcomas remain challenging and complex surgical problems with significant potential for postoperative impairment of ambulation, as well as bowel, bladder, and sexual function. En bloc resection with negative tumor margins represents the best chance of control or cure as current adjuvant therapies remain ineffective. Tumor involvement of the sacrum with extension to the greater sciatic notch and ipsilateral ilium requires an external hemipelvectomy and sagittal sacrectomy with sacrifice of the lower extremity to achieve en bloc resection, followed by lumbar-pelvic reconstruction. A patient with an iliosacral chondrosarcoma is presented to illustrate a novel lumbar-pelvic reconstruction technique, in which vascularized soft tissue and 2 vascularized bone grafts were harvested from the amputated lower extremity and transferred to the pelvis as composite flaps to restore pelvic ring integrity, augment lumbar-pelvic fusion, and close the soft-tissue defect. The biomechanical dynamics of this unique construct are discussed.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Ehud Mendel, M.D., Department of Neurosurgery, # N1037 Doan Hall, The Ohio State University Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210. email: ehud.mendel@osumc.edu.

Please include this information when citing this paper: published online April 22, 2011; DOI: 10.3171/2011.3.SPINE10569.

  • 1

    Ackerman DB, , Rose PS, , Moran SL, , Dekutoski MB, , Bishop AT, & Shin AY: The results of vascularized-free fibular grafts in complex spinal reconstruction. J Spinal Disord Tech [epub ahead of print] 2010

    • Search Google Scholar
    • Export Citation
  • 2

    Arata MA, , Wood MB, & Cooney WP III: Revascularized segmental diaphyseal bone transfers in the canine. An analysis of viability. J Reconstr Microsurg 1:1119, 1984

    • Search Google Scholar
    • Export Citation
  • 3

    Beadel GP, , McLaughlin CE, , Aljassir F, , Turcotte RE, , Isler MH, & Ferguson P, : Iliosacral resection for primary bone tumors: is pelvic reconstruction necessary?. Clin Orthop Relat Res 438:2229, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Bergh P, , Gunterberg B, , Meis-Kindblom JM, & Kindblom LG: Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 91:12011212, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Bramer JA, & Taminiau AH: Reconstruction of the pelvic ring with an autograft after hindquarter amputation: improvement of sitting stability and prosthesis support. Acta Orthop 76:453454, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Choudry UH, , Moran SL, & Karacor Z: Functional reconstruction of the pelvic ring with simultaneous bilateral free fibular flaps following total sacral resection. Ann Plast Surg 57:673676, 2006

    • Search Google Scholar
    • Export Citation
  • 7

    Combalía A, , Fernández-Valencia JA, , Ramón R, , Segur JM, , García S, & Suso S: Long-term results of hemipelvic allograft: report of four cases. Cell Tissue Bank 3:4144, 2002

    • Search Google Scholar
    • Export Citation
  • 8

    Cutting CB, & McCarthy JG: Comparison of residual osseous mass between vascularized and nonvascularized onlay bone transfers. Plast Reconstr Surg 72:672675, 1983

    • Search Google Scholar
    • Export Citation
  • 9

    Fourney DR, , Rhines LD, , Hentschel SJ, , Skibber JM, , Wolinsky JP, & Weber KL, : En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:111122, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Gunterberg B, , Romanus B, & Stener B: Pelvic strength after major amputation of the sacrum. An exerimental study. Acta Orthop Scand 47:635642, 1976

    • Search Google Scholar
    • Export Citation
  • 11

    Hsieh PC, , Xu R, , Sciubba DM, , McGirt MJ, , Nelson C, & Witham TF, : Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine (Phila Pa 1976) 34:22332239, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Moran SL, , Bakri K, , Mardini S, , Shin AY, & Bishop AT: The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects. Microsurgery 29:393400, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Randall RL, , Bruckner J, , Lloyd C, , Pohlman TH, & Conrad EU III: Sacral resection and reconstruction for tumors and tumor-like conditions. Orthopedics 28:307313, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Sakuraba M, , Kimata Y, , Iida H, , Beppu Y, , Chuman H, & Kawai A: Pelvic ring reconstruction with the double-barreled vascularized fibular free flap. Plast Reconstr Surg 116:13401345, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Todd LT Jr, , Yaszemski MJ, , Currier BL, , Fuchs B, , Kim CW, & Sim FH: Bowel and bladder function after major sacral resection. Clin Orthop Relat Res 397:3639, 2002

    • Search Google Scholar
    • Export Citation
  • 16

    Winters HA, , van Engeland AE, , Jiya TU, & van Royen BJ: The use of free vascularised bone grafts in spinal reconstruction. J Plast Reconstr Aesthet Surg 63:516523, 2010

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 624 155 13
Full Text Views 186 37 4
PDF Downloads 138 18 2
EPUB Downloads 0 0 0