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Reconstruction of a Large External Hemipelvectomy Defect After Chordoma Resection Using a 5-Component Chimeric Rotational Flap

Durden, Frederick MD*; Wang, Duane BS; Mendel, Ehud MD; Tiwari, Pankaj MD

doi: 10.1097/SAP.0b013e31828bb2fa
Reconstructive Surgery

Management of complex lumbosacral neoplastic disease presents unique challenges and requires a multidisciplinary approach. Large pelvic tumors may require external hemipelvectomy where an entire lower extremity including the hemipelvis is removed with disarticulation of the sacroiliac joint and symphysis pubis. When external hemipelvectomy is performed, the reconstructive surgeon must consider osseous reconstruction for structural pelvic support, the elimination of dead space, protection of implanted hardware, intra-abdominal support, and skin coverage. Reconstruction must minimize wound healing morbidity, operative time and the number of operative sites, and maximize the potential for rehabilitation. We present a case demonstrating use of a rotational chimeric flap for the reconstruction of an external hemipelvectomy defect.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE; Departments of †Plastic Surgery and ‡Neurosurgery, Wexner Medical Center at the Ohio State University, Columbus, OH.

Received June 21, 2012, and accepted for publication, after revision, February 5, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Pankaj Tiwari, MD, Department of Plastic Surgery, Wexner Medical Center at the Ohio State University, 915 Olentangy River Rd, Suite 2100, Columbus, OH. E-mail:

Frederick Durden was responsible for writing credits and figure creation/formatting, and was the surgeon involved in reconstruction described in letter; Duane Wang, writing credits and literature review; Pankaj Tiwari, writing credits and was the attending surgeon along with Ehud Mendel performing the reconstruction described in letter.

As this letter involves discussion of a single case, it is exempt from needing IRB approval by our institution. In addition, no HIPAA review or approval is required. However, patient confidentiality was protected at all times.

© 2015 by Lippincott Williams & Wilkins