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Hu X, Wen Y, Lu M, Luo Y, Zhou Y, Yang X, Tu C, Min L. Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study. J Orthop Surg Res 2024; 19:258. [PMID: 38654343 DOI: 10.1186/s13018-024-04697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively. METHODS From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution. PRIMARY OUTCOME limb function. SECONDARY OUTCOMES implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models. RESULTS In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher. CONCLUSIONS The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions. LEVEL OF EVIDENCE Level III, therapeutic study (Retrospective comparative study).
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Wen
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, 643000, People's Republic of China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, Sichuan, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Sullivan MH, Mills GL, Saifuddin H, Brinkman EJ, Carlsen BT, Moran SL, Houdek MT. Targeted Muscle Reinnervation to Reduce Postoperative Pain in Patients Undergoing Hindquarter Resections. Anticancer Res 2023; 43:3513-3516. [PMID: 37500121 DOI: 10.21873/anticanres.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND/AIM Pre-emptive targeted muscle reinnervation (TMR) at the time of amputation results in less phantom limb pain (PLP) compared with untreated amputee controls. There is limited literature describing the technique in patients undergoing hindquarter amputation despite up to 90% of these patients reporting PLP and 50% presenting with painful neuroma. The purpose of the current study was to describe the motor nerves accessible through a primary hind-quarter amputation to be used for TMR and review pain outcomes in clinical case correlates of patients with TMR. PATIENTS AND METHODS Six limbs were obtained from three fresh adult cadavers and proximal sensory and motor nerves were dissected. A review of patients undergoing hindquarter amputation with TMR was conducted. RESULTS Transfers for the sciatic, femoral, and obturator nerves were identified in cadavers. In reviews of patients, they were taking narcotic and neuro-leptic pain medication for a mean of 23 days and 168 days. At most recent follow-up, no patient reported debilitating phantom pain nor pain associated with neuromas. CONCLUSION Given the positive preliminary results in our study group as well as the accessible neuroanatomy, pre-emptive TMR should be considered at the time of surgery to limit PLP and dependence on pain medications.
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Affiliation(s)
| | - Gavin L Mills
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Hiba Saifuddin
- Division of Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, LA, U.S.A
| | - Elyse J Brinkman
- Department of Orthopedic Surgery, University of Washington, Seattle, WA, U.S.A
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.;
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Mahran MA, Khalifa AA, El-Sayed A. Pelvis reconstruction by proximal femur upshifting and total hip arthroplasty after radical resection of an adolescent patient pelvic Ewing's sarcoma, a case report, and literature review. Int J Surg Case Rep 2023; 106:108146. [PMID: 37068459 PMCID: PMC10130465 DOI: 10.1016/j.ijscr.2023.108146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pelvis reconstruction after tumor resection poses a challenge, especially in younger patients where preserving the patient's function and mobility is paramount. CASE PRESENTATION A 16 years old female presented in March 2019 with vague right iliac area pain, diagnosed as pelvic Ewing's sarcoma after imaging studies (MRI and MSCT scan) and obtaining an incisional biopsy. After initial chemotherapy cycles, the tumor decreased in size, and surgical intervention in two stages was performed. The first stage was in October 2019 and consisted of pelvic resection type I and II according to Enneking and Dunham classification, proximal femur upshifting to compensate for the pelvic bone defect, and a cement spacer to fill the space of the resected proximal femur. The second stage was performed after two months and consisted of implanting a total hip arthroplasty using Megaprostheses and a cementless dual mobility acetabular cup. No local recurrence or distant metastases were detected during follow-ups. At the final follow up after 36 months, the patient showed acceptable functional outcomes (HHS score 83, and MSTS score 23 (76.7 %) points), and the radiographs showed proper implant positioning and stability. CLINICAL DISCUSSION Treating pelvic Ewing's sarcoma requires a multidisciplinary team. After surgical resection, the pelvic reconstruction options include using allografts or autografts, femur upshifting, and hemipelvis prostheses, which should be chosen considering patients and tumor characteristics as well as surgical team efficiency. CONCLUSION Reconstructing the pelvic defect after bone tumor resection by proximal femoral upshifting is a valid biological option with acceptable outcomes.
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Affiliation(s)
- Mohamed A Mahran
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Amr El-Sayed
- Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University Hospitals and School of Medicine, Assiut, Egypt
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Schindler M, Baertl S, Walter N, Lang S, Szymski D, Alt V, Rupp M. Retrospective analysis of mortality and quality of life after hip disarticulation or hemipelvectomy: a report on 15 patients. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04783-4. [PMID: 36723759 PMCID: PMC10374469 DOI: 10.1007/s00402-023-04783-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip disarticulation and hemipelvectomy are defined as major ablative amputations of the lower limb. Due to the small number of patients, little is known about the outcome and follow-up. AIMS We aimed to assess (1) reasons for performed major ablative surgeries such as hip disarticulation and hemipelvectomy in a German center for trauma and orthopedic surgery. (2) In addition, mortality and quality of life after hip disarticulation and hemipelvectomy as well as (3) patient and treatment characteristics should be investigated. METHODS During a period of twelve years, 15 patients underwent hip disarticulation or hemipelvectomy. Mortality, EQ-5D-3L quality of life by EQ-5D-3L and time-trade-off (TTO), VAS, cause of disarticulation, length of hospital stays, revisions, comorbidities, Charlson comorbidity index (CCI), and ASA score were evaluated retrospective for all patients. RESULTS The overall mortality rates were 26.7% at 30 days, 60.0% after one year and 66.7% after three years. The five surviving patients reported about moderate problems in the EQ-5D-3L. The average VAS score reached 45 (range 15-65). The mean TTO was 9.8 (range 6-12). Indications for amputation were infection (n = 7), tumor (n = 6), trauma (n = 1) and ischemia (n = 1). CONCLUSION Hip disarticulation and hemipelvectomy are followed by a high postoperative mortality. Quality of life of the affected patients is impaired in long-term follow-up. Especially amputations performed due to infections show high mortality within one month after surgery despite average young age and low CCI. Surgeons should be aware of this devastating outcome and extraordinary vigilant for these vulnerable patient cohorts.
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Affiliation(s)
- Melanie Schindler
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Susanne Baertl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Gosheger G, Ahrens H, Dreher P, Schneider KN, Deventer N, Budny T, Heitkötter B, Schulze M, Theil C. Evaluation of a novel classification system to predict local recurrence in sarcoma patients undergoing hemipelvectomy with iliosacral resection. Bone Joint J 2022; 104-B:290-296. [PMID: 35094575 DOI: 10.1302/0301-620x.104b2.bjj-2021-1180.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Iliosacral sarcoma resections have been shown to have high rates of local recurrence (LR) and poor overall survival. There is also no universal classification for the resection of pelvic sarcomas invading the sacrum. This study proposes a novel classification system and analyzes the survival and risk of recurrence, when using this system. METHODS This is a retrospective analysis of 151 patients (with median follow-up in survivors of 44 months (interquartile range 12 to 77)) who underwent hemipelvectomy with iliosacral resection at a single centre between 2007 and 2019. The proposed classification differentiates the extent of iliosacral resection and defines types S1 to S6 (S1 resection medial and parallel to the sacroiliac joint, S2 resection through the ipsilateral sacral lateral mass to the neuroforamina, S3 resection through the ipsilateral neuroforamina, S4 resection through ipsilateral the spinal canal, and S5 and S6 contralateral sacral resections). Descriptive statistics and the chi-squared test were used for categorical variables, and the Kaplan-Meier survival analysis were performed. RESULTS Resections were S1 in 25/151 patients (17%), S2 in 70/151 (46%), S3 in 33/151 (22%), S4 in 77/151 (11%), S5 in 4/151 (3%), and S6 in 2/151 (1%). An internal hemipelvectomy was performed in 113/151 patients (75%), and 38/151 patients (25%) had an external hemipelvectomy. The predominant types of sarcoma were high-grade osteosarcoma in 48/151 patients (32%), chondrosarcoma in 41/151 (27%), Ewing sarcoma in 33/151 (22%), pleomorphic sarcoma in 17/151 (11%), and others in 2/151 (8%). LR was found in 24/151 patients (15%) with S3, S5, with S6 resections showing the highest rate of LR (p = 0.038). Overall, 19/151 patients (16%) had evidence of metastastic disease at the time of surgery and these patients showed poorer survival when compared to patients with no metastasis. CONCLUSION The proposed classification can help to report and compare different surgical and reconstructive approaches in these difficult cases who are still have a considerable risk of LR. Cite this article: Bone Joint J 2022;104-B(2):290-296.
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Affiliation(s)
- Georg Gosheger
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Helmut Ahrens
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Philipp Dreher
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Kristian N Schneider
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Niklas Deventer
- Gerhard-Domagk-Institut of Pathology, Münster University Hospital, Münster, Germany
| | - Tymoteusz Budny
- Gerhard-Domagk-Institut of Pathology, Münster University Hospital, Münster, Germany
| | - Birthe Heitkötter
- Gerhard-Domagk-Institut of Pathology, Münster University Hospital, Münster, Germany
| | - Martin Schulze
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Christoph Theil
- Department of General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
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Korambayil SM, Iyer S, Williams DJ. Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital. Ann R Coll Surg Engl 2021; 103:e223-e226. [PMID: 34192495 DOI: 10.1308/rcsann.2021.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hip disarticulation is the removal of the entire lower limb through the hip joint by detaching the femur from the acetabulum. This major ablative procedure is rarely performed for infection but may be required in severe necrotising fasciitis. We present a single centre retrospective review of all cases of emergency hip disarticulations in patients with necrotising fasciitis between 2010 and 2020. All five patients included in the review presented with acute lower limb pain and sepsis. Three patients had comorbidities predisposing them to necrotising fasciitis. Three were deemed to be high risk and two were at intermediate risk of developing necrotising fasciitis. There were two deaths in the postoperative period. Of the three survivors, two required revision surgery for a completion hindquarter amputation and one for flap closure. All three survivors had good functional outcomes after discharge from hospital. Despite its associated morbidity, emergency amputation of the entire lower limb is a life-saving treatment in cases of rapidly progressing necrotising fasciitis and should be considered as a first-line option in managing this condition.
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Affiliation(s)
| | - S Iyer
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | - D J Williams
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
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Ahlawat S, McColl M, Morris CD, Fayad LM. Pelvic bone tumor resection: post-operative imaging. Skeletal Radiol 2021; 50:1303-1316. [PMID: 33399942 DOI: 10.1007/s00256-020-03703-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/14/2020] [Accepted: 12/25/2020] [Indexed: 02/02/2023]
Abstract
The anatomic extent of a pelvic bone tumor and the need for reconstruction dictate the type of pelvic resection (limb salvage pelvic resection or amputation). If a pelvic bone tumor resection involves two or more critical anatomic structures (the sciatic nerve, femoral neurovascular bundle or the hip joint), then reasonable functional recovery after limb salvage is less likely and amputation should be considered. Both limb salvage and amputation approaches to the pelvis are technically arduous surgeries with significant associated morbidity and complications. As such, imaging plays an important role in the post-operative management of patients who have undergone pelvic bone tumor resection. In this article, we will review optimal imaging techniques as well as the expected post-operative appearance after pelvic bone tumor resection and important complications including infection, tumor recurrence, and complications related to complex soft tissue and osseous reconstruction.
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Affiliation(s)
- Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Michael McColl
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Carol D Morris
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
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Jamshidi K, Zandrahimi F, Bagherifard A, Mohammadi F, Mirzaei A. Type lll internal hemipelvectomy for primary bone tumours with and without allograft reconstruction : a comparison of outcomes. Bone Joint J 2021; 103-B:1155-1159. [PMID: 34058885 DOI: 10.1302/0301-620x.103b6.bjj-2020-2149.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM There is insufficient evidence to support bony reconstruction of the pubis after a type III internal hemipelvectomy (resection of all or part of the pubis). In this study, we compared surgical complications, postoperative pain, and functional outcome in a series of patients who had undergone a type III internal hemipelvectomy with or without bony reconstruction. METHODS In a retrospective cohort study, 32 patients who had undergone a type III hemipelvectomy with or without allograft reconstruction (n = 15 and n = 17, respectively) were reviewed. The mean follow-up was 6.7 years (SD 3.8) for patients in the reconstruction group and 6.1 years (SD 4.0) for patients in the non-reconstruction group. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system and the level of postoperative pain with a visual analogue scale (VAS). RESULTS The mean MSTS score of the patients was significantly better in patients after reconstruction (26 (SD 1.7) vs 22.7 (SD 2.0); p < 0.001). The mean visual analogue scale score for pain was significantly less in the reconstruction group (2.1 (SD 2) vs 4.2 (SD 2.2); p = 0.016). One infection occurred in each group. Bladder herniation occurred in three patients (17.6%) in the non-reconstruction group but none in the reconstruction group. Five patients (29.4%) in the non-reconstruction group and one (7%) in the reconstruction group had a limp. Graft displacement occurred in two patients in the reconstruction group. CONCLUSION We recommend reconstruction of the bony defect after a type III hemipelvectomy: it gives a better functional result, less postoperative pain, and fewer late surgical complications. Cite this article: Bone Joint J 2021;103-B(6):1155-1159.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Zandrahimi
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Al-Wageeh S, Ahmed F, Al-Naggar K, Askarpour MR, Al-Shami E. Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report. Surg Case Rep 2020; 6:247. [PMID: 33000349 PMCID: PMC7527394 DOI: 10.1186/s40792-020-01009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.
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Affiliation(s)
- Saleh Al-Wageeh
- Department of General Surgery, Ibb University of Medical Science, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Science, Alodine Street, Ibb, Yemen.
| | - Khalil Al-Naggar
- Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Science, Ibb, Yemen
| | | | - Ebrahim Al-Shami
- Department of Urology, Urology Research Center, Ibb University of Medical Science, Al-Thora hospital, Ibb, Yemen
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Hope WC, Ferro LC, Snyder JA, Procter LD, Salluzzo JL. Hemipelvectomy hernia: case series and literature review. Hernia 2020; 25:1159-1167. [PMID: 32700157 DOI: 10.1007/s10029-020-02258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hemipelvectomy is a major operation in which significant portions of the pelvic girdle and lower extremity are resected. The development of hernia following hemipelvectomy is a complex surgical challenge with limited published guidelines for management. We present our experience with three cases of hernia repair following internal hemipelvectomy and review the previously described ten cases of similar patients. METHODS A systematic review of the current literature regarding hernias in the setting of hemipelvectomy was performed. A comprehensive search strategy on MEDLINE/PUBMED database searching for the key words of hemipelvectomy and hernia was used. RESULTS There were 13 reported cases of incisional hernia after hemipelvectomy. The indication for hemipelvectomy was sarcoma in 77% of cases. The median time to presentation for hernia repair was 3 years following initial resection. Mesh repair was used in 77%. Identified risk factors for the development of incisional hernia included chemoradiation, wound infection, multiple operations, and weight gain. There was one event of hernia recurrence with a mean follow-up of 16 months. CONCLUSION Hernia in the setting of hemipelvectomy is an infrequently reported problem. General principles in management are similar to all hernia repairs and include local approximation of tissues, avoidance of contamination or wound infection, and use of prosthetic mesh when local tissue is inadequate for a tension-free repair.
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Affiliation(s)
- W C Hope
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery - Virginia Commonwealth University Health System, P.O. Box 980645, Richmond, VA, USA
| | - L C Ferro
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery - Virginia Commonwealth University Health System, P.O. Box 980645, Richmond, VA, USA
| | - J A Snyder
- Department of Surgery, Wellspan Good Samaritan Hospital, Lebanon, PA, USA
| | - L D Procter
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery - Virginia Commonwealth University Health System, P.O. Box 980645, Richmond, VA, USA
| | - J L Salluzzo
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery - Virginia Commonwealth University Health System, P.O. Box 980645, Richmond, VA, USA.
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McColl M, Fayad LM, Morris C, Ahlawat S. Pelvic bone tumor resection: what a radiologist needs to know. Skeletal Radiol 2020; 49:1023-1036. [PMID: 32072185 DOI: 10.1007/s00256-020-03395-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023]
Abstract
Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to be large and located in close proximity to pelvic viscera as well as vital neurovascular structures. Operative management of pelvic bone tumors is indicated for a variety of orthopedic oncologic conditions. In general, limb-sparing pelvic resection rather than hemipelvectomy with amputation of the ipsilateral limb is considered when a functional limb can be preserved without compromising the surgical margins. There are various options for pelvic resection and reconstruction, and the selection depends on tumor histology, anatomic location, and extent. The decision regarding choice of surgical procedure and reconstruction method for a pelvic bone tumor requires a thorough knowledge of the pelvic anatomy, and careful inspection of the anatomic extent. The surgical plan must strike a balance between acceptable functional outcome and acceptable morbidity. In this review, we describe the different types of pelvic resection techniques, and the vital role preoperative imaging plays in defining the anatomic extent of a pelvic bone tumor and subsequent surgical planning.
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Affiliation(s)
- Michael McColl
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Carol Morris
- Division of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, 21287, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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Abstract
AIMS Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or have identified factors associated with the consequences. The present study aimed to: 1) determine the rate of wound and other complications requiring surgery after internal hemipelvectomy; and 2) identify factors that affect the rate of wound complications and can be used to stratify patients by risk of wound complications. METHODS The medical records of 123 patients undergoing internal hemipelvectomy were retrospectively reviewed, with a focus on both overall complications and wound complications. Logistic regression analyses were performed to examine the association between host, tumour, and surgical factors and rates of postoperative wound complications. RESULTS The overall rate of postoperative complications requiring surgery was 49.6%. Wound complications were observed in 34.1% of patients, hardware-related complications in 13.2%, graft-related complications in 9.1%, and local recurrence in 5.7%. On multivariate analysis, extrapelvic tumour extension (odds ratio (OR) 23.28; 95% confidence interval (CI), 1.97 to 274.67; p = 0.012), both intra- and extrapelvic tumour extension (OR 46.48; 95% CI, 3.50 to 617.77; p = 0.004), blood transfusion ≥ 20 units (OR 50.28; 95% CI, 1.63 to 1550.32; p = 0.025), vascular sacrifice of the internal iliac artery (OR 64.56; 95% CI, 6.33 to 658.43; p < 0.001), and use of a structural allograft (OR, 6.57; 95% CI, 1.70 to 25.34; p = 0.001) were significantly associated with postoperative wound complications. CONCLUSION Internal hemipelvectomy is associated with high rates of morbidity, especially wound complications. Several host, tumour, and surgical variables are associated with wound complications. The ability to stratify patients by risk of wound complications can help refine surgical and wound-healing planning and may lead to better outcomes in patients undergoing internal hemipelvectomy. Cite this article: Bone Joint J 2020;102-B(3):280-284.
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Affiliation(s)
- Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick J Boland
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicola Fabbri
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. Affiliated with Weill Medical College of Cornell University, New York, New York, USA
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Hardes J, Guder W, Streitbürger A, Podleska L, Rödder P, Täger G, Dudda M, Nottrott M. [Treatment concepts for complications after resection and defect reconstruction of pelvic tumours]. Orthopade 2020; 49:133-141. [PMID: 31996946 DOI: 10.1007/s00132-020-03882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partial pelvic resection, internal hemipelvectomy or sacrectomy as a result of bone sarcoma is still challenging. No matter what kind of reconstruction is used, there is still a much higher rate of complications in pelvic surgery compared to sarcoma surgery of the long bones. OBJECTIVES We describe the most common complications in pelvic sarcoma surgery and specific complications related to the reconstruction method. Handling strategies for these complications are specified. METHODS We performed a literature search and report our own experiences in the troubleshooting of pelvic surgery-related complications to gain an up-to-date overview of the state-of-the-art in management strategies. RESULTS Prospective randomized trials or meta-analyses on this topic are lacking. The literature search depicted that, besides local recurrence, deep infection after reconstruction is the most serious complication. An early revision with radical debridement has to be performed in order to save the reconstruction. In the case of a deep infection, the removal of all implants with a total loss of the reconstruction is often unavoidable. Therefore, an individualized risk-benefit analysis prior to surgery with respect to the type of reconstruction, or no reconstruction at all (hip transposition), together with the patient is advisable. CONCLUSIONS Complications-especially infections-after hemipelvectomy or sacrectomy are common. In the case of infection, in some cases, an early revision is the only chance to prevent a reconstruction from explantation.
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Affiliation(s)
- J Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - W Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - L Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - P Rödder
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - G Täger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Dudda
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - M Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Kreutz-Rodrigues L, Weissler JM, Moran SL, Carlsen BT, Mardini S, Houdek MT, Rose PS, Bakri K. Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthet Surg 2019; 73:242-254. [PMID: 31703941 DOI: 10.1016/j.bjps.2019.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/31/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS We performed a retrospective chart review of patients who underwent hemipelvectomy and fillet flap reconstruction from 2001 to 2018. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications of patients were reviewed. RESULTS Ten patients were identified and included. Their mean age was 51 ± SD 12.4 years. Six patients underwent standard external hemipelvectomy and 4 patients underwent extended external hemipelvectomy. Seven lower extremity fillet flaps were performed as free tissue transfers, and 3 were pedicled flaps. The mean flap size was 1,153 ± SD 1137 cm2. The mean follow-up was 5 months (range: 1-24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION Reconstruction with pedicled or free lower extremity fillet flaps is a valuable reconstructive approach, for managing large soft tissue defects following hemipelvectomy when the standard anterior and posterior thigh flaps are unavailable or inadequate for complete soft tissue coverage. This useful technique mitigates donor site morbidity, while simultaneously achieving massive soft tissue coverage with an acceptable complication profile.
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Affiliation(s)
- Lucas Kreutz-Rodrigues
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Brian T Carlsen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Jansen H, Heintel TM, Jordan M, Meffert RH, Frey SP. Survived traumatic hemipelvectomy with salvage of the limb in a 14 months old toddler. Trauma Case Rep 2019; 22:100220. [PMID: 31289739 PMCID: PMC6593344 DOI: 10.1016/j.tcr.2019.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/28/2022] Open
Abstract
We report on a 14 months old toddler who sustained a traumatic hemipelvectomy by being crushed between a car and a stone wall. After stabilization in the resuscitation room he was treated operatively by laparotomy, osteosynthesis of the pelvic ring, reconstruction of the both external iliac vessels and the urethra and reposition of the testicles. After 66 days he was discharged into rehabilitation. Implants were removed after eight months. 20 months after the injury, the leg was plegic, initial radiological signs of femoral head necrosis showed up but the infant was able to walk with an orthesis and a walker. Up to our knowledge, this is the youngest patient described in the literature with a survived traumatic hemipelvectomy and salvaged limb.
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Affiliation(s)
- Hendrik Jansen
- Dept. of Trauma-, Hand-, Plastics- and Reconstructive Surgery, University Clinics Wuerzburg, Oberduerrbacher Str. 6, D-97080 Wuerzburg, Germany
| | - Timo M Heintel
- Dept. of Trauma-, Hand-, Plastics- and Reconstructive Surgery, University Clinics Wuerzburg, Oberduerrbacher Str. 6, D-97080 Wuerzburg, Germany
| | - Martin Jordan
- Dept. of Trauma-, Hand-, Plastics- and Reconstructive Surgery, University Clinics Wuerzburg, Oberduerrbacher Str. 6, D-97080 Wuerzburg, Germany
| | - Rainer H Meffert
- Dept. of Trauma-, Hand-, Plastics- and Reconstructive Surgery, University Clinics Wuerzburg, Oberduerrbacher Str. 6, D-97080 Wuerzburg, Germany
| | - Soenke P Frey
- Dept. of Orthopaedics and Trauma Surgery, St. Josef Hospital Bochum, University Clinics Bochum, Germany
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Abstract
Objective: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs. Methods: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients’ demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery. Results: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively. Conclusions: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression. Level of Evidence: IV, case series.
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Roulet S, Le Nail LR, Vaz G, Babinet A, Dumaine V, Sallot A, Rosset P. Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation. Orthop Traumatol Surg Res 2019; 105:47-54. [PMID: 30595412 DOI: 10.1016/j.otsr.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/26/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option. HYPOTHESIS The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation. MATERIAL AND METHODS Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented. RESULTS Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis. DISCUSSION The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France.
| | - Louis-Romée Le Nail
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
| | - Gualter Vaz
- Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - Antoine Babinet
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Valérie Dumaine
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Aurélie Sallot
- Département de chirurgie plastique et reconstructive, centre hospitalo-universitaire de Tours - faculté de médecine, université de Tours, 37000 Tours, France
| | - Philippe Rosset
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
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Faenza M, Pieretti G, Lamberti R, Di Costanzo P, Napoletano A, Di Martino M, Casale F, Ferraro GA, Nicoletti GF. Limberg fasciocutaneous transposition flap for the coverage of an exposed hip implant in a patient affected by ewing sarcoma. Int J Surg Case Rep 2018; 41:516-519. [PMID: 29546030 PMCID: PMC5723282 DOI: 10.1016/j.ijscr.2017.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022] Open
Abstract
Hemipelvectomy with immediate reconstruction with prosthetic devices for the surgical treatment of malignant tumors is an invasive procedure. The treatment of an exposed hip implant in these cluster of patient is extremely challenging and the literature shows how negative pressure wound therapy and myocutaneous, both pedicled and free, flaps are workhorses in these situations. The literature shows that the gold standard in the coverage of exposed prosthetic devices and in the treatment of infected non healing wounds is represented by muscular or myocutaneous flap. In this paper we report a successful coverage of exposed prosthetic hip implant with a local fasciocutaneous flap in a patient in which any other kind of reconstruction was not feasible.
Introduction Hemipelvectomy with immediate reconstruction with prosthetic devices for the surgical treatment of malignant tumors is an invasive procedure with many possible complications such as wound breakdown, seroma, hematoma and infection. The treatment of an exposed hip implant in these cluster of patient is extremely challenging and the literature shows how negative pressure wound therapy and myocutaneous, both pedicled and free, flaps are workhorses in these situations. Case report In this paper we report a successful coverage of exposed prosthetic hip implant with a local fasciocutaneous flap in a patient in which any other kind of reconstruction was not feasible. Discussion Fasciocutaneous flaps can be considered as an easily performed and minimally invasive surgical procedure, particularly reliable even in patients in poor general conditions, with preservation of future flap options.
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Affiliation(s)
- Mario Faenza
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy; Traslational Medicine of Development and Active Aging, Università degli Studi di Salerno, Via Giovanni Paolo II, 132-84084, Fisciano (Salerno), Italy.
| | - Gorizio Pieretti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
| | - Rossella Lamberti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
| | - Pasquale Di Costanzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
| | - Antonio Napoletano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
| | - Martina Di Martino
- Department of Women, Child and General and Specialist Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Paediatric Oncology Unit, Vico Luigi De Crecchio, 2-80138 Naples, Italy
| | - Fiorina Casale
- Department of Women, Child and General and Specialist Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Paediatric Oncology Unit, Vico Luigi De Crecchio, 2-80138 Naples, Italy
| | - Giuseppe A Ferraro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
| | - Giovanni F Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 1-80138 Naples, Italy
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Garcia JG, Martinez A, Filho RJG, Petrilli MT, Viola DC. Epidemiological characteristics of patients with pelvic tumors submitted to surgical treatment. Rev Bras Ortop 2018; 53:33-37. [PMID: 29367904 PMCID: PMC5771795 DOI: 10.1016/j.rboe.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Describe the epidemiological profile of patients with primary or secondary neoplastic lesions in the pelvis who required a surgical procedure such as hemipelvectomy. Methods This study retrospectively evaluated 69 patients located in the database of a São Paulo educational institution, subject to surgical hemipelvectomy treatment between January 1990 and December 2013. All patients had previous diagnosis of bone tumor (primary or metastatic) in the pelvis (ilium, ischium, pubis, and/or sacrum). Results Analyzing the data obtained in this study, it was observed that these are partly similar to those found in the literature, with primary bone malignancies as the main diagnosis; general injuries affecting the pelvic area I (pelvic bone) and its most frequent complication, infection. The differences are mainly due to rarity of the bone tumors evaluated in this study, and the type of surgical procedure in question, which is even more unusual. Conclusion Building a picture that conveys the reality of each diagnosis and that indicates which characteristics of these patients would better resemble an absolute or relative indication for the realization of hemipelvectomy is harder by the rarity of these cases.
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Kadhim M, Womer RB, Dormans JP. Surgical treatment of pelvic sarcoma in children: outcomes for twenty six patients. Int Orthop 2017; 41:2149-2159. [PMID: 28752206 DOI: 10.1007/s00264-017-3564-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Pelvic sarcoma is uncommon in children and challenging to treat. This study examined different surgical approaches to treat pelvic sarcoma with the aim of assessing the oncologic, and functional outcomes. METHODS We retrospectively examined the medical records of patients younger than 21 years of age who underwent surgery for pelvic sarcoma at our institution from 1992 to 2010. The functional status of the patients was examined after a minimum follow-up of two years. RESULTS Twenty-six patients were included in the analysis. Nineteen (73%) patients were male and seven (27%) were female. Mean age at presentation was 12.0 ± 3.9 years. Nineteen patients had Ewing sarcoma (73%), five had osteosarcoma (19%), one had chondrosarcoma (4%) and one had rhabdomyosarcoma (4%). Iliac wing resection with no reconstruction was done in three patients. Reconstruction with free fibular graft A-frame was performed in four patients, saddle endoproshtesis in five patients, iliac autoclave in one patient, and internal hemipelvectomy in nine patients. Hindquarter amputation was performed in five patients. Median follow-up was 4.6 years (range, 2.6-16 years). Nineteen patients were alive (73%); of those, 13 were known to be without disease, three were with disease and three did not have known tumor status. Six patients were reported deceased, three had osteosarcoma and three had Ewing sarcoma. Function was assessed in 17 patients; 64% were asymptomatic and ambulatory and 36% were symptomatic and ambulatory. CONCLUSIONS Salvage reconstruction for pelvic sarcoma can be performed through various procedures on the extent of necessary bony resection. Survival rate and functional outcomes were promising in the performed study.
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Affiliation(s)
- Muayad Kadhim
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard B Womer
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John P Dormans
- Department of Orthopaedics, Texas Children's Hospital, 6701 Fannin St CC660, Houston, TX, 77030, USA.
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Couto AG, Araújo B, Torres de Vasconcelos RA, Renni MJ, Da Fonseca CO, Cavalcanti IL. Survival rate and perioperative data of patients who have undergone hemipelvectomy: a retrospective case series. World J Surg Oncol 2016; 14:255. [PMID: 27716330 DOI: 10.1186/s12957-016-1001-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background Hemipelvectomy is a major orthopedic surgical procedure indicated in specific situations. Although many studies discuss surgical techniques for hemipelvectomy, few studies have presented survival data, especially in underdeveloped countries. Additionally, there is limited information on anesthesia for orthopedic oncologic surgeries. The primary aim of this study was to determine the survival rate after hemipelvectomy, and the secondary aims were to evaluate anesthesia and perioperative care associated with hemipelvectomy and determine the influence of the surgical technique (external hemipelvectomy [amputation] or internal hemipelvectomy [limb sparing surgery]) on anesthesia and perioperative care in Brazil. Methods This retrospective case series collected data from 35 adult patients who underwent hemipelvectomy between 2000 and 2013. Survival rates after surgery were determined, and group comparisons were performed using the Kaplan–Meier method and the log-rank test. Mantel–Cox test and multiple linear regression analysis with stepwise forward selection were performed for univariate and multivariate analyses, respectively. Results Mean survival time was 32.8 ± 4.6 months and 5-year survival rate was 27 %. Of the 35 patients, 23 patients (65.7 %) underwent external hemipelvectomy and 12 patients (34.3 %) underwent internal hemipelvectomy. The survival rate was significantly higher in patients with bone tumors than in those with soft tissue sarcomas (P = 0.024). The 5-year cumulative probability of survival was significantly lower in patients who underwent external hemipelvectomy than in those who underwent internal hemipelvectomy (P = 0.043). In the univariate and multivariate analyses, only advanced disease stage (3 and 4) was identified as a significant independent predictor of reduced survival (P = 0.0003). Balanced general anesthesia combined with epidural block was the most frequent anesthesia technique. Median intraoperative crystalloid volume and red blood cell transfusions were 3500 mL and 2 units, respectively. Conclusions Overall mean survival time after hemipelvectomy was 32.8 months. Advanced disease stage might be independently associated with reduced survival. Smaller amounts of fluids and transfusions were administered and time to discharge was shorter. Acute and chronic pain as well as wound complications are still important challenges in hemipelvectomy.
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Houdek MT, Andrews K, Kralovec ME, Kotajarvi B, Smither FC, Shives TC, Rose PS, Sim FH. Functional outcome measures of patients following hemipelvectomy. Prosthet Orthot Int 2016; 40:566-72. [PMID: 25896186 DOI: 10.1177/0309364615574164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/23/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Major amputations are indicated for curative treatment of some tumors of the pelvis. Previous literature suggests that patients with a hemipelvectomy amputation are more efficient walking with crutches than using a prosthesis. OBJECTIVES The purpose of this study was to evaluate whether modern prosthetic use after hemipelvectomy may be a viable option for patients than in the past. STUDY DESIGN Case control trial. METHODS We identified five patients who underwent hemipelvectomy amputation and fit with high-level prosthetic components. Patients were evaluated using a timed up and go, 5-m walk, 400-m walk, and stair climb tests to evaluate functional performance with a prosthesis and without. Short Form-36 scores were collected as well. These results were compared to matched controls. RESULTS There was a trend for faster locomotion using crutches over wearing a prosthesis in the timed up and go, and 5-m and 400-m walk; no difference was seen in stair climbing. Short Form-36 scores showed decreased physical component score, but equal mental component score compared to the general population. CONCLUSION Our results show that in addition to advances in surgical techniques, prosthetic rehabilitation and management are beginning to optimize functional mobility with the prosthesis. CLINICAL RELEVANCE Patients who use a modern prosthesis following hemipelvectomy demonstrated good clinical function with and without their prosthesis. Although health status scores were decreased in the physical component, mental component scores were equal to healthy controls.
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Abstract
Objective: To show the experience of the Erasto Gaertner Hospital with hemipelvectomy surgery over a 10-year period. Methods: This was a retrospective study on 32 patients who underwent hemipelvectomy at Erasto Gaertner Hospital between 1998 and 2008, assessing clinical and surgical characteristics. Results: Among the 32 patients, 15 were female and 17 were male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: three were located in the iliac and extended to the thigh, two were in the acetabulum and extended to the thigh and three were in the acetabulum and pubis. Twenty-three cases presented a neurovascular bundle free from neoplasia: 11 were restricted to the iliac, six were in the acetabular region, two were in the pubic ramus and four extended to the whole hemipelvis bone. One case involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and four cases of Ewing's sarcoma represented the majority. Eight cases underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; four were type II; two were type II + III; three were type III and four were type IV). Of these 24 cases, 13 did not have any reconstruction, 10 had a fibular graft and one had an iliacfemoral vein and artery prosthesis. Twenty-six surgeries were curative and six were palliative. There were 14 deaths. Survival of two and five years was seen in 11 and 10 cases, respectively. For six cases, less than two years had passed since the operation. Three cases were lost during follow-up. Conclusion: This study shows the experiences of an oncology reference service specializing in highly complex surgical treatment.
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Affiliation(s)
| | | | | | - Múrio Armani Neto
- Orthopedists in the Oncological Orthopedics Service, Erasto Gaertner Hospital, Curitiba, PR
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Schaal Wilson RE. Rehabilitation considerations for a patient with external hemipelvectomy and hemisacrectomy for recurrent soft tissue pelvic sarcoma: a case report. Physiother Theory Pract 2015. [PMID: 26196700 DOI: 10.3109/09593985.2015.1023480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE External hemipelvectomy (EHP) is an uncommon procedure involving surgical amputation of the lower extremity and hemipelvis. Soft tissue sarcomas of the pelvis are rare and accompanied by a high risk of disease progression after surgical intervention. The purpose of this case report is to describe the rehabilitation considerations and importance of interdisciplinary collaboration to achieve functional goals to allow discharge with improved independence and decreased caregiver burden. CASE DESCRIPTION A 58-year-old Caucasian male patient underwent a hemipelvectomy and hemisacrectomy for treatment of a recurrent pelvic soft tissue sarcoma following 4 months of bed confinement secondary to pain and weakness of the involved lower extremity. This report outlines the physical therapy interventions during 3 weeks of inpatient rehabilitation. CONCLUSION This case demonstrates that continuous interdisciplinary care of a complex patient with EHP and hemisacrectomy contributes to significant improvement in functional mobility exceeding prior level of function. This case is particularly interesting because in addition to having a rare diagnosis and undergoing an uncommon surgical procedure, this patient was confined to bed for 4 months prior to surgical intervention, and thus began rehabilitation with a baseline of limited functional mobility and high caregiver burden.
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Arnal-Burró J, Calvo-Haro JA, Igualada-Blazquez C, Gil-Martínez P, Cuervo-Dehesa M, Vaquero-Martín J. [ Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:67-74. [PMID: 26091572 DOI: 10.1016/j.recot.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.
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Haim S, Laufer Y, Leonid K, Daniel G, Yechiel S, Zeev Z, Yury G, Asher KA, Michal EG. Hemipelvectomy after severe pelvic injury in Factor VII deficiency toddler. Injury 2014; 46:1178-82. [PMID: 25733368 DOI: 10.1016/j.injury.2014.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/30/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Traumatic hemipelvectomy is a lethal catastrophic injury. The reported average age of individuals surviving this trauma is 21 years old, suggesting the necessity of good physiological reserves to survive this type of injury. Dealing with this injury in children may call for special requirements throughout all the stages of diagnosis, treatment and rehabilitation. Experience in the resuscitation and subsequent treatment of individuals suffering from this traumatic condition in the paediatric population is even scarce. There are only several reported cases involving children and none of the paediatric cases suffered from comorbidities prior to their traumatic injury. The present report describes the successful management of a 16-month-old child with a medical history of a rare bleeding disorder a severe coagulation Factor VII deficiency who underwent right-sided traumatic hemipelvectomy.
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Affiliation(s)
- Shtarker Haim
- Pediatric Orthopaedics, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel.
| | - Yocheved Laufer
- Physical Therapy Department, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Kogan Leonid
- Department of Plastic Surgery, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Glikman Daniel
- Infectious Diseases Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Sweed Yechiel
- Department of Pediatric Surgery, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Zonis Zeev
- Pediatric Intensive Care Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Grozovsky Yury
- Vascular Surgery Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Kuperman Amir Asher
- Pediatric Hematology and Coagulation Service, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Elboim-Gabyzon Michal
- Physical Therapy Department, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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Raciborska A, Bilska K, Rychlowska-Pruszynska M, Drabko K, Chaber R, Pogorzała M, Połczyńska K, Godziński J, Rodriguez-Galindo C, Wożniak W. Internal hemipelvectomy in the management of pelvic Ewing sarcoma - are outcomes better than with radiation therapy? J Pediatr Surg 2014; 49:1500-4. [PMID: 25280655 DOI: 10.1016/j.jpedsurg.2014.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function. MATERIALS AND METHODS Thirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000-2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT. RESULTS Twenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol. CONCLUSIONS Internal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.
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Affiliation(s)
- Anna Raciborska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
| | - Katarzyna Bilska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Radosław Chaber
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pogorzała
- Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Połczyńska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godziński
- Department of Paediatric Surgery Marciniak Hospital, Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - Carlos Rodriguez-Galindo
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, TX
| | - Wojciech Wożniak
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
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Gebert C, Wessling M, Gosheger G, Aach M, Streitbürger A, Henrichs MP, Dirksen U, Hardes J. Pelvic reconstruction with compound osteosynthesis following hemipelvectomy: A clinical study. Bone Joint J 2013; 95-B:1410-6. [PMID: 24078542 DOI: 10.1302/0301-620x.95b10.31123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To date, all surgical techniques used for reconstruction of the pelvic ring following supra-acetabular tumour resection produce high complication rates. We evaluated the clinical, oncological and functional outcomes of a cohort of 35 patients (15 men and 20 women), including 21 Ewing's sarcomas, six chondrosarcomas, three sarcomas not otherwise specified, one osteosarcoma, two osseous malignant fibrous histiocytomas, one synovial cell sarcoma and one metastasis. The mean age of the patients was 31 years (8 to 79) and the latest follow-up was carried out at a mean of 46 months (1.9 to 139.5) post-operatively. We undertook a functional reconstruction of the pelvic ring using polyaxial screws and titanium rods. In 31 patients (89%) the construct was encased in antibiotic-impregnated polymethylmethacrylate. Preservation of the extremities was possible for all patients. The survival rate at three years was 93.9% (95% confidence interval (CI) 77.9 to 98.4), at five years it was 82.4% (95% CI 57.6 to 93.4). For the 21 patients with Ewing's sarcoma it was 95.2% (95% CI 70.7 to 99.3) and 81.5% (95% CI 52.0 to 93.8), respectively. Wound healing problems were observed in eight patients, deep infection in five and clinically asymptomatic breakage of the screws in six. The five-year implant survival was 93.3% (95% CI 57.8 to 95.7). Patients were mobilised at a mean of 3.5 weeks (1 to 7) post-operatively. A post-operative neurological defect occurred in 12 patients. The mean Musculoskeletal Tumor Society score at last available follow-up was 21.2 (10 to 27). This reconstruction technique is characterised by simple and oncologically appropriate applicability, achieving high primary stability that allows early mobilisation, good functional results and relatively low complication rates.
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Affiliation(s)
- C Gebert
- Orthopaedic Hospital Volmarstein, Department of Tumour & Revision Surgery, Lothar-Gau-Str. 11, D-58300 Wetter, and The University of Muenster, Germany
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Oliveira AF, Vieira LJ, do Nascimento ACR, de Paula Fraga JB, Costa RRL, do Nascimento LGR. INTERNAL HEMIPELVECTOMY: REPORT ONEIGHT CASES. Rev Bras Ortop 2012; 47:776-9. [PMID: 27047900 PMCID: PMC4799484 DOI: 10.1016/s2255-4971(15)30038-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 12/13/2012] [Indexed: 11/28/2022] Open
Abstract
Internal hemipelvectomy is a surgical procedure adequate for treatment of certain tumors of the pelvic girdle. Being a lower limb-preserving approach, it is a therapeutic alternative to the classical interilioabdominal amputation and hip joint disarticulation. According to Enneking's classification, there are four types of internal hemipelvectomies, although the association of different types of resection in the same procedure is feasible if necesary. This surgical approach should be correctly indicated to positively affect the patient's morbidity, mortality and quality of life. We report eight cases of internal hemipelvectomy in patients diagnosed with tumors of the pelvic girdle. We also discuss the neoadjuvant and adjuvant treatments used, along with their follow-up.
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Affiliation(s)
- Alexandre Ferreira Oliveira
- Specialization in Oncological Surgery at the Brazilian National Cancer Institute (INCA) - RJ; Doctor's degree in Surgery, FMUSP; Associate Professor of Oncology at the Universidade Federal de Juiz de Fora - Juiz de Fora, MG, Brazil
| | - Leonardo José Vieira
- Specialization in Oncological Surgery at Hospital AC Camargo, São Paulo, SP; Head, Oncological Surgery Clinic, Hospital ASCOMCER - Juiz de Fora, MG, Brazil
| | - Antônio Carlos Rodrigues do Nascimento
- Academic in Medicine, Universidade Federal de Juiz de Fora; Fellow of the Professional Training Program in Oncology/Oncological Surgical, FM/UFJF - Juiz de Fora, MG, Brazil
| | - João Baptista de Paula Fraga
- Specialization in Coloproctology, Hospital Heliópolis, SP; Full Member of the Brazilian Society of Coloproctology - São Paulo, SP, Brazil
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30
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Dallagnol JC, de Freitas RR, Crivellaro ALS, Mello GJP, Neto MA, Filho GDF. RECONSTRUCTION FOLLOWING EXTENSIVE TUMOR RESECTION OF THE PELVIC AND SCAPULAR GIRDLE: A REPORT OF TWO CASES. Rev Bras Ortop 2012; 47:118-23. [PMID: 27027091 PMCID: PMC4799356 DOI: 10.1016/s2255-4971(15)30355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022] Open
Abstract
Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases – one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.
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Affiliation(s)
- Juliana Corrêa Dallagnol
- General Surgeons. Oncological Surgery Residents of the Hospital Erasto Gaertner – Uberaba, Curitiba, PR, Brazil
- Correspondence: R. Pe. Julio Saavedra, 74, casa 4 Uberaba, Curitiba - PR. CEP: 81570-180Correspondence: R. Pe. Julio Saavedra74, casa 4 UberabaCuritibaPRCEP: 81570-180
| | - Rosyane Rena de Freitas
- General Surgeons. Oncological Surgery Residents of the Hospital Erasto Gaertner – Uberaba, Curitiba, PR, Brazil
| | | | - Glauco José Pauka Mello
- Orthopedists of the Oncology Orthopedics Service Hospital Erasto Gaertner – Uberaba, Curitiba, PR, Brazil
| | - Mário Armani Neto
- Orthopedists of the Oncology Orthopedics Service Hospital Erasto Gaertner – Uberaba, Curitiba, PR, Brazil
| | - Geraldo de Freitas Filho
- Orthopedists of the Oncology Orthopedics Service Hospital Erasto Gaertner – Uberaba, Curitiba, PR, Brazil
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