ORIGINAL ARTICLE Immediate Reconstruction of Oncologic Hemipelvectomy Defects Kevin Knox, MD,* Ioannis Bitzos, MD,* Mark Granick, MD,* Ramazi Datiashvili, MD,* Joseph Benevenia, MD,† and Francis Patterson, MD† Background: Soft tissue and bony tumors of the pelvis are rare, but when they occur, treatment presents both an oncologic surgical and a reconstructive challenge. After reconstruction, soft tissue defects can be large and there is usually exposed bone and/or joint. A retroperitoneal abdominal wall defect may also be present. Flap mobilization is generally necessary to eliminate dead space and cover the exposed bone, viscera, and/or prosthetic orthopedic ma- terial. We performed immediate reconstruction on 11 patients after radical pelvic resections for tumor. Patients and Methods: Eleven cases of radical pelvic resection and immediate reconstruction were identified during the period from 1992 to 2002 at University Hospital, Newark, New Jersey. All patients were treated by both the orthopedic oncology and plastic surgery teams. A retrospective review of office charts and hospital records was performed. Data were gathered regarding the following: tumor type and oncologic history, extent of resection, reconstructive modality, complications, and outcome. Results: All patients underwent radical resection of pelvic masses depending on the tumor type and location. Tumor types included chondrosarcoma (6), Paget osteosarcoma (1), giant cell tumor (1), metastatic uterine carcinoma (2), and invasive squamous cell carci- noma arising in a chronic decubitus ulcer (1). The reconstructive procedures performed were the following: rectus abdominus flaps (6), gluteus maximus musculocutaneous flaps (3), and thigh fillet flaps (2). The retroperitoneal defects were repaired with primary tissue approximation of the surrounding available musculature. Ad- ditionally, Gore-Tex mesh was used in 2 cases, tensor fascia lata was used in 2 cases, and acellular dermal matrix in 1 case. Blood loss for the combined procedures ranged from 400 mL to 1400 mL. The follow-up period in this series ranged from 24 to 114 months. Complications included skin flap loss with subsequent infection (1), local cellulitis controlled with antibiotics (1), regional recurrence (2). The postoperative course was uneventful for the remainder of the cases. Conclusion: Soft tissue reconstructions after extensive pelvic resec- tions always present as complex reconstructive problems. Recon- struction is dictated by the size of the defects and by tissue avail- ability. The extent and type of resections vary according to tumor size and location. In our experience, local pedicled muscle-based flaps, if available, usually provide adequate tissue mass to eliminate dead space, cover the extent of the wound, and close the retroperi- toneal defect. Microvascular tissue transfer is always an option but was reserved in our series for cases with no suitable local alternative. Key Words: pelvic, immediate reconstruction, oncologic (Ann Plast Surg 2006;57: 184 –189) S oft tissue and bony tumors of the pelvis are often large at the time of diagnosis and generally present with com- plaints of vague abdominal pain or fullness. Rarely do they present with symptoms suggestive of advanced malignancy. These tumors are often missed with plain radiographs in which the bony pelvis is invariably obscured by the presence of gas in the overlying intestines. As such, multiple imaging modalities are needed to determine the full extent of these lesions. 1 The large size of these tumors in conjunction with the limited volume of the pelvis, its complex shape, and numerous muscle attachments often creates a dangerous sit- uation in which these tumors reside in close approximation to vessels, nerve bundles, and viscera within the pelvis. As a result, surgical management of these lesions presents a sig- nificant technical challenge, particularly in obtaining ade- quate margins to prevent local recurrence while attempting to optimize the postoperative function of involved joints and limbs. Resection of these tumors usually creates large soft tissue defects with retroperitoneal abdominal wall defects, as well as exposed bone and joint surfaces, and exposed ortho- pedic hardware. Although resection of pelvic tumors can be a demand- ing undertaking, reconstruction of the pelvic architecture and closure of the soft tissue defect created by resection of these lesions can pose an equally difficult challenge. For example, because such a large amount of pelvic tissue and bone are removed during excision of the tumor, resulting defects can leave behind unsupported bowel which can adhere to devas- cularized surfaces of the pelvis resulting in intestinal obstruc- tions and ultimately fistula formation. 7 Received November 7, 2005, and accepted for publication February 9, 2006. From the *Department of Surgery, Division of Plastic Surgery, and the †De- partment of Orthopedic Surgery, New Jersey Medical School–University of Medicine and Dentistry of New Jersey, Newark, New Jersey. Correspondence: Mark Granick, MD, Department of Surgery, Division of Plastic Surgery, University of Medicine and Dentistry—New Jersey Medical School, PO Box 1709, Newark, NJ 07101. E-mail: mgranickmd@umdnj.edu. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 0148-7043/06/5702-0184 DOI: 10.1097/01.sap.0000215288.83924.6c Annals of Plastic Surgery • Volume 57, Number 2, August 2006 184