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Risk Factors Associated with Reconstructive Complications Following Sacrectomy

Vartanian, Emma D., MD*; Lynn, Jeremy V., BA; Perrault, David P., BA; Wolfswinkel, Erik M., MD*; Kaiser, Andreas M., MD§; Patel, Ketan M., MD*; Carey, Joseph N., MD*; Hsieh, Patrick C., MD; Wong, Alex K., MD*

Plastic and Reconstructive Surgery – Global Open: November 5, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002002
Latest Articles: PDF Only

Background: Sacral pathology requiring partial or total sacrectomy is rare, and reconstructing the ensuing defects requires careful decision-making to minimize morbidity. The purpose of this study was to review the experience of a single institution with reconstructing large sacral defects, to identify risk factors for suboptimal outcomes.

Methods: A retrospective chart review was conducted of all patients who underwent sacrectomy over a 10-year period. Univariate analysis of differences in risk factors between patients with and without various postoperative complications was performed. Multivariate logistic regression was used to identify predictive variables.

Results: Twenty-eight patients were identified. The most common diagnosis leading to sacrectomy was chordoma (39%). Total sacrectomy was performed on 4 patients, whereas 24 patients underwent partial resection. Reconstructive modalities included 15 gluteal advancement flaps, 4 pedicled rectus abdominis myocutaneous flaps, and 9 paraspinous muscle or other flap types. There was an overall complication rate of 57.1% (n = 12) and a 28.6% (n = 8) incidence of major complications. There were significantly more flap-related complications in patients who underwent total sacrectomy (P = 0.02). Large defect size resulted in significantly more unplanned returns to the operating room (P < 0.01).

Conclusion: Consistent with other published series', the overall complication rate exceeded 50%. Defect volume and sacrectomy type were the strongest predictors of postoperative complications and return to the operating room, while reconstructive strategy showed limited power to predict patient outcomes. We recommend that patients anticipated to have large sacral defects should be appropriately counseled regarding the incidence of wound complications, regardless of reconstructive approach.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *USC Division of Plastic and Reconstructive Surgery, Los Angeles, Calif.

University of Michigan, Ann Arbor, Mich.

USC Keck School of Medicine, Los Angeles, Calif.

§USC Division of Colorectal Surgery, Los Angeles, Calif.

USC Department of Neurological Surgery, Los Angeles, Calif.

Published online 5 November 2018.

Received for publication August 26, 2018; accepted September 14, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Alex K. Wong, MD, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90030, E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.