Total "internal" hemipelvectomy.

Several authors have described resections of tumorbearing parts of the pelvis including reconstructive plastic surgery. With extensive tumor growth present mutilating hemipelvectomies often have been the last resort. Even the most sophisticated prostheses hardly ever enabled the patients to walk again. We have therefore performed total "internal" hemipelvectomies in three cases. The necessary substitute consisted of half a pelvis made of polyacetal resin produced from a given model. The model's measures and shape was established by computer tomograms thus resulting in an individually shaped pelvis half. The operative procedure aims at the maintenance of osseous muscular insertions and origins and their reconstruction. Utmost care has to be taken in avoiding damage to nerves and vessels. Fixation of the implant is performed by screws aiming through the sacroiliac joint into ala and corpus of the sacrum and corticocancellous grafts incorporated in the implant. The symphyses are united by means of plate fixation. The hip joint is substituted by a total prosthesis. With the procedure described we have managed three cases of extensive malignant tumors of the pelvis. One patient suffered a nerve lesion and skin necrosis with infection. The two remaining patients are capable of weight-bearing and standing on the inflicted leg alone.