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Reconstruction of the Pelvic Ring with Vascularized Double-Strut Fibular Flap following Internal Hemipelvectomy

Chang, David W. M.D.; Fortin, Amanda J. M.D.; Oates, Scott D. M.D.; Lewis, Valerae O. M.D.

Plastic & Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - pp 1993-2000
doi: 10.1097/PRS.0b013e3181706ff2
Reconstructive: Trunk: Original Articles

Background: After internal hemipelvectomy, successful pelvic reconstruction can provide a durable and pain-free reconstruction for the young, active patient. Such reconstruction is extremely challenging, and often patients have less than optimal ambulation with a limp, leg length discrepancy, or leg instability. The authors present an innovative method for pelvic ring reconstruction using a vascularized double-strut fibular bone flap that provides a stable pelvis and recovery of normal or near-normal gait.

Methods: From December of 2003 to November of 2005, six sarcoma patients underwent internal hemipelvectomy and pelvic ring reconstruction with a vascularized double-strut fibular bone flap. The length of each strut was 7 to 12 cm.

Results: All bone flaps survived. The mean follow-up was 18 months (range, 8 to 32 months). Radiographic evidence of bone bridging was seen at a mean of 2.5 months (range, 2 to 4 months). The mean time to ambulation without assistance was 8 months (range, 5 to 18 months). One patient died as a result of metastatic disease. The remaining five patients are ambulatory with a mild limp or no limp.

Conclusion: Use of a vascularized double-strut fibular bone flap for pelvic ring reconstruction is effective in facilitating early ambulation and restoring normal to near-normal gait in patients undergoing internal hemipelvectomy.

Houston, Texas

From the Departments of Plastic Surgery and Surgical Oncology, University of Texas M. D. Anderson Cancer Center.

Received for publication March 12, 2007; accepted May 14, 2007.

Presented at the 60th Annual Meeting of the Canadian Society of Plastic Surgeons, in Quebec City, Quebec, Canada, June 14 through 17, 2006.

Disclosure: The authors have no financial interests to disclose.

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David W. Chang, M.D., Department of Plastic Surgery, Unit 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, dchang@mdanderson.org

©2008American Society of Plastic Surgeons