Knox Kevin, Bitzos Ioannis, Granick Mark, Datiashvili Ramazi, Benevenia Joseph, Patterson Francis
Department of Surgery, Division of Plastic Surgery, New Jersey Medical School - University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
Ann Plast Surg. 2006 Aug;57(2):184-9. doi: 10.1097/01.sap.0000215288.83924.6c.
Soft tissue and bony tumors of the pelvis are rare, but when they occur, treatment presents both an oncologic surgical and a reconstructive challenge. After reconstruction, soft tissue defects can be large and there is usually exposed bone and/or joint. A retroperitoneal abdominal wall defect may also be present. Flap mobilization is generally necessary to eliminate dead space and cover the exposed bone, viscera, and/or prosthetic orthopedic material. We performed immediate reconstruction on 11 patients after radical pelvic resections for tumor.
Eleven cases of radical pelvic resection and immediate reconstruction were identified during the period from 1992 to 2002 at University Hospital, Newark, New Jersey. All patients were treated by both the orthopedic oncology and plastic surgery teams. A retrospective review of office charts and hospital records was performed. Data were gathered regarding the following: tumor type and oncologic history, extent of resection, reconstructive modality, complications, and outcome.
All patients underwent radical resection of pelvic masses depending on the tumor type and location. Tumor types included chondrosarcoma (6), Paget osteosarcoma (1), giant cell tumor (1), metastatic uterine carcinoma (2), and invasive squamous cell carcinoma arising in a chronic decubitus ulcer (1). The reconstructive procedures performed were the following: rectus abdominus flaps (6), gluteus maximus musculocutaneous flaps (3), and thigh fillet flaps (2). The retroperitoneal defects were repaired with primary tissue approximation of the surrounding available musculature. Additionally, Gore-Tex mesh was used in 2 cases, tensor fascia lata was used in 2 cases, and acellular dermal matrix in 1 case. Blood loss for the combined procedures ranged from 400 mL to 1400 mL. The follow-up period in this series ranged from 24 to 114 months. Complications included skin flap loss with subsequent infection (1), local cellulitis controlled with antibiotics (1), regional recurrence (2). The postoperative course was uneventful for the remainder of the cases.
Soft tissue reconstructions after extensive pelvic resections always present as complex reconstructive problems. Reconstruction is dictated by the size of the defects and by tissue availability. The extent and type of resections vary according to tumor size and location. In our experience, local pedicled muscle-based flaps, if available, usually provide adequate tissue mass to eliminate dead space, cover the extent of the wound, and close the retroperitoneal defect. Microvascular tissue transfer is always an option but was reserved in our series for cases with no suitable local alternative.
骨盆的软组织和骨肿瘤较为罕见，但一旦发生，治疗在肿瘤外科手术和重建方面都具有挑战性。重建后，软组织缺损可能很大，通常会有暴露的骨骼和/或关节。也可能存在腹膜后腹壁缺损。一般需要进行皮瓣转移以消除死腔并覆盖暴露的骨骼、内脏和/或矫形假体材料。我们对11例因肿瘤行根治性骨盆切除术后的患者进行了即刻重建。
1992年至2002年期间，在新泽西州纽瓦克大学医院确定了11例根治性骨盆切除并即刻重建的病例。所有患者均由骨科肿瘤团队和整形外科团队共同治疗。对门诊病历和医院记录进行了回顾性分析。收集了以下数据：肿瘤类型和肿瘤病史、切除范围、重建方式、并发症及结果。
所有患者均根据肿瘤类型和位置进行了骨盆肿块的根治性切除。肿瘤类型包括软骨肉瘤（6例）、佩吉特骨肉瘤（1例）、巨细胞瘤（1例）、转移性子宫癌（2例）以及慢性褥疮引起的浸润性鳞状细胞癌（1例）。所进行的重建手术如下：腹直肌皮瓣（6例）、臀大肌肌皮瓣（3例）和大腿肌皮瓣（2例）。腹膜后缺损采用周围可用肌肉组织的一期缝合修复。另外，2例使用了 Gore-Tex 补片，2例使用了阔筋膜张肌，1例使用了脱细胞真皮基质。联合手术的失血量在400毫升至1400毫升之间。本系列患者的随访期为24至114个月。并发症包括皮瓣坏死伴随后感染（1例）、经抗生素控制的局部蜂窝织炎（1例）、局部复发（2例）。其余病例术后过程顺利。
广泛骨盆切除术后的软组织重建始终是复杂的重建问题。重建取决于缺损大小和可用组织情况。切除范围和类型因肿瘤大小和位置而异。根据我们的经验，如果有可用的局部带蒂肌皮瓣，通常可提供足够的组织量以消除死腔、覆盖伤口范围并闭合腹膜后缺损。微血管组织转移始终是一种选择，但在我们的系列中仅用于没有合适局部替代方案的病例。
