J Reconstr Microsurg 2007; 23(03): 137-142
DOI: 10.1055/s-2007-974648
Original Article

Microsurgical Fibular Flap for Pelvic Ring Reconstruction after Periacetabular Tumor Resection

Guangrong Yu
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
Feng Zhang
2   Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
,
Jiaqian Zhou
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
Shimin Chang
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
Liming Cheng
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
Yongwei Jia
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
Haifeng Li
1   Department of Orthopedic Surgery, Tongji University, Tongji Hospital, Shanghai, China
,
William C Lineaweaver
2   Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
› Author Affiliations

Abstract

Reconstruction after resection of tumor about the acetabulum represents a considerable challenge in reconstructive surgery. Between 1999 and 2003, three patients with periacetabular tumors underwent tumor resections (Ennecking type B) and pelvic ring reconstruction with microsurgical fibular flaps. Histological diagnosis showed oseosarcoma, giant cell tumor, and aneurysmoid bone cyst. All patients survived surgery without complications. The follow-up for patients ranged from 14 to 42 months. The average time for bone healing and full weight bearing was 13.6 weeks after surgery. In evaluations of the functional outcome using Enneking scoring system, two reached the score of excellent (≥ 23 points), and one reached the score of good (15 to 22 points). This report shows our experience in use of microsurgical fibular flaps for arthrodesis of the hip after periacetabular tumor resection, which restores the continuity of the pelvic ring with minimal shortening of the limb.



Publication History

Publication Date:
04 May 2007 (online)

© 2007. Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Thieme Medical Publishers

 
  • REFERENCES

  • 1 Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 1978; 60: 731-746
  • 2 Salzer M, Knahr K, Sekera J, Braun O. Resection treatment of malignant pelvic bone tumors. In: Enneking WF Limb Salvage in Musculoskeletal Oncology New York: Churchill Livingstone; 1987: 112-117
  • 3 Apffelstaedt JP, Driscoll DL, Karakousis CP. Partial and complete internal hemipelvectomy: Complications and long-term follow-up. J Am Coll Surg 1995; 181: 43-48
  • 4 Gradinger R, Rechl H, Hipp E. Pelvic osteosarcoma: resection, reconstruction, local control, and survival statistics. Clin Orthop Relat Res 1991; 270: 149-158
  • 5 Walker RH. Pelvic reconstruction/total hip arthroplasty for metastatic acetabular insufficiency. Clin Orthop Relat Res 1993; 294: 170-175
  • 6 Harrington KD. The use of hemipelvic allografts or autoclaved grafts for reconstruction after wide resections of malignant tumors of the pelvis. J Bone Joint Surg Am 1992; 74: 331-341
  • 7 Satcher Jr RL, O'Donnell RJ, Johnston JO. et al. Reconstruction of the pelvis after resection of tumors about the acetabulum. Clin Orthop Relat Res 2003; 409: 209-217
  • 8 Steel HH. Partial or complete resection of the hemipelvis. An alternative to hindquarter amputation for periacetabular chondrosacoma of the pelvis. J Bone Joint Surg Am 1978; 60: 719-730
  • 9 Takami M, Ieguchi M, Takamatsu K. et al. Functional evaluation of flail hip joint after periacetabular resection of the pelvis. Osaka City Med J 1997; 43: 173-183
  • 10 Fuchs B, O'Connor MI, Kaufman KR. et al. Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation. Clin Orthop Relat Res 2002; 397: 29-35
  • 11 Nieder E, Elson RA, Engelbrecht E. et al. The saddle prosthesis for salvage of the destroyed acetabulum. J Bone Joint Surg Br 1990; 72: 1014-1022
  • 12 Cottias P, Jeanrot C, Vinh TS. et al. Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors. J Surg Oncol 2001; 78: 90-100
  • 13 Ozaki T, Hoffmann C, Hillmann A. et al. Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop Relat Res 2002; 396: 197-205
  • 14 Langlais F, Lambotte JC, Thomazeau H. Long-term results of hemipelvis reconstruction with allografts. Clin Orthop Relat Res 2001; 388: 178-186
  • 15 Leung PC. Reconstruction of the pelvic ring after tumour resection. Int Orthop 1992; 16: 168-171
  • 16 Yajima H, Tamai S. Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity. Clin Orthop Relat Res 1994; 303: 178-184
  • 17 Nagoya S, Usui M, Wada T, Yamashita T, Ishii S. Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours. J Bone Joint Surg Br 2000; 82: 1121-1124
  • 18 Fuchs B, Yaszemski MJ, Sim FH. Combined posterior pelvis and lumbar spine resection for sarcoma. Clin Orthop Relat Res 2002; 397: 12-18
  • 19 Sakuraba M, Kimata Y, Iida H, Beppu Y, Chuman H, Kawai A. Pelvic ring reconstruction with the double-barreled vascularized fibular free flap. Plast Reconstr Surg 2005; 116: 1340-1345
  • 20 de Kleuver M, Kooijman MA, Kauer JM, Kooijman HM, Alferink C. Pelvic osteotomies: anatomic pitfalls at the ischium. A cadaver study. Arch Orthop Trauma Surg 1998; 117: 376-378
  • 21 Weiland AJ. Vascularized bone transfers. Instr Course Lect 1984; 33: 446-460
  • 22 Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993; 286: 241-246
  • 23 Capanna R, Guernelli N, Ruggieri P. Periacetabular pelvic resections. In: Enneking WF Limb Salvage in Musculoskeletal Oncology New York: Churchill Livingstone; 1987: 141-146
  • 24 Bieber EJ, Wood MB. Bone reconstruction. Clin Plast Surg 1986; 13: 645-655
  • 25 Gonzalez del Pino J, Bartolome del Valle E, Grana GL, Villanova JF. Free vascularized fibular grafts have a high union rate in atrophic nonunions. Clin Orthop Relat Res 2004; 419: 38-45
  • 26 Tang CH. Reconstruction of the bones and joints of the upper extremity by vascularized free fibular graft: Report of 46 cases. J Reconstr Microsurg 1992; 8: 285-292
  • 27 Yajima H, Tamai S, Ono H, Kizaki K, Yamauchi T. Free vascularized fibula grafts in surgery of the upper limb. J Reconstr Microsurg 1999; 15: 515-521
  • 28 Pederson WC. Upper extremity microsurgery. Plast Reconstr Surg 2001; 107: 1524-1537
  • 29 Yajima H, Tamai S. Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity. Clin Orthop Relat Res 1994; 303: 178-184
  • 30 Oswald TM, Lineaweaver WC, Hui K. Recipient vessels for microsurgical flaps to the groin and pelvis: a review. J Reconstr Microsurg 2006; 22: 5-14