Reconstruction of Internal Hemipelvectomy Defects After Oncologic Resection.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
04 Sep 2024
04 Sep 2024
Historique:
received:
13
06
2023
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
6
9
2024
Statut:
aheadofprint
Résumé
Internal hemipelvectomy is preferred to hindquarter amputation for pelvic tumor resection if a functional lower extremity can be obtained without compromising oncologic principles; multidisciplinary advances in orthopaedic and plastic surgery reconstruction have made this possible. The goals of skeletal reconstruction are restoration of pelvic and spinopelvic skeletal continuity, maintenance of limb length, and creation of a functional hip joint. The goals of soft-tissue reconstruction are stable coverage of skeletal, prosthetic, and neurovascular structures, elimination of dead space, and prevention of herniation. Pelvic resections are divided into four types: type I (ilium), type II (acetabulum), type III (ischiopubic rami), and type IV (sacrum). Type I and IV resections resulting in pelvic discontinuity are often reconstructed with vascularized bone flaps and instrumentation. Type II resections, which traditionally result in the greatest functional morbidity, are often reconstructed with hip transposition, allograft, prosthesis, and allograft-prosthetic composites. Type III resections require soft-tissue repair, sometimes with flaps and mesh, but generally no skeletal reconstruction. Extension of resection into the sacrum can result in additional skeletal instability, neurologic deficit, and soft-tissue insufficiency, necessitating a robust reconstructive strategy. Internal hemipelvectomy creates complex deficits that often require advanced multidisciplinary reconstructions to optimize outcomes and minimize complications.
Identifiants
pubmed: 39241189
doi: 10.5435/JAAOS-D-23-00502
pii: 00124635-990000000-01087
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the American Academy of Orthopaedic Surgeons.
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