Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps

Hormuzdiyar H. Dasenbrock, Michelle J. Clarke, Ali Bydon, Timothy F Witham, Daniel Sciubba, Oliver P. Simmons, Ziya L. Gokaslan, Jean Paul Wolinsky

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Performing a sacrectomy from an exclusively posterior approach allows the en bloc resection of tumors without the morbidity of a laparotomy. However, reconstruction of the resultant extensive soft-tissue defects is challenging because a vertical rectus abdominis myocutaneous flap is not harvested. OBJECTIVE: To report the largest series (with the longest follow-up) of sacral reconstructions using a combination of human acellular dermal matrix (HADM) and gluteus maximus myocutaneous flaps. METHODS: Thirty-four patients with sacral tumors with a follow-up of at least 1 year were reviewed retrospectively. After the tumor was excised, HADM (AlloDerm, LifeCell Corp, Branchburg, New Jersey) was secured to create a pelvic diaphragm. Subsequently, the gluteus maximus muscles were freed from their origins and advanced to cover the HADM. RESULTS: The mean age of patients was 50.1 years (SD, 16.0 years), and the histopathology was a chordoma in 82.4%. Seven patients (20.6%) developed a postoperative wound dehiscence, 5 of whom (14.7%) required operative debridement. An estimated blood loss of >1500 mL, an operative time of >9 hours during sacrectomy, and postoperative bowel incontinence were associated with a significantly higher likelihood of undergoing a subsequent debridement for dehiscence (P ≤ .03). With a mean follow-up of 45.7 months, only 1 patient developed an asymptomatic parasacral hernia. CONCLUSION: Reconstruction of posterior sacrectomy defects with HADM and gluteus maximus myocutaneous flaps may be valid. This approach may have rates of wound dehiscence comparable to other techniques and low rates of parasacral herniation.

Original languageEnglish (US)
Pages (from-to)1240-1247
Number of pages8
JournalNeurosurgery
Volume69
Issue number6
DOIs
StatePublished - Dec 2011

Fingerprint

Acellular Dermis
Myocutaneous Flap
Debridement
Neoplasms
Chordoma
Rectus Abdominis
Pelvic Floor
Wounds and Injuries
Operative Time
Hernia
Laparotomy
Morbidity
Muscles

Keywords

  • Chordoma
  • Gluteus maximus myocutaneous flap
  • Human acellular dermal matrix
  • Sacral hernia
  • Sacral reconstruction
  • Sacral tumors
  • Sacrectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps. / Dasenbrock, Hormuzdiyar H.; Clarke, Michelle J.; Bydon, Ali; Witham, Timothy F; Sciubba, Daniel; Simmons, Oliver P.; Gokaslan, Ziya L.; Wolinsky, Jean Paul.

In: Neurosurgery, Vol. 69, No. 6, 12.2011, p. 1240-1247.

Research output: Contribution to journalArticle

Dasenbrock, Hormuzdiyar H. ; Clarke, Michelle J. ; Bydon, Ali ; Witham, Timothy F ; Sciubba, Daniel ; Simmons, Oliver P. ; Gokaslan, Ziya L. ; Wolinsky, Jean Paul. / Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps. In: Neurosurgery. 2011 ; Vol. 69, No. 6. pp. 1240-1247.
@article{04e53944ff93436c9a3269355cefa1b1,
title = "Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps",
abstract = "BACKGROUND: Performing a sacrectomy from an exclusively posterior approach allows the en bloc resection of tumors without the morbidity of a laparotomy. However, reconstruction of the resultant extensive soft-tissue defects is challenging because a vertical rectus abdominis myocutaneous flap is not harvested. OBJECTIVE: To report the largest series (with the longest follow-up) of sacral reconstructions using a combination of human acellular dermal matrix (HADM) and gluteus maximus myocutaneous flaps. METHODS: Thirty-four patients with sacral tumors with a follow-up of at least 1 year were reviewed retrospectively. After the tumor was excised, HADM (AlloDerm, LifeCell Corp, Branchburg, New Jersey) was secured to create a pelvic diaphragm. Subsequently, the gluteus maximus muscles were freed from their origins and advanced to cover the HADM. RESULTS: The mean age of patients was 50.1 years (SD, 16.0 years), and the histopathology was a chordoma in 82.4{\%}. Seven patients (20.6{\%}) developed a postoperative wound dehiscence, 5 of whom (14.7{\%}) required operative debridement. An estimated blood loss of >1500 mL, an operative time of >9 hours during sacrectomy, and postoperative bowel incontinence were associated with a significantly higher likelihood of undergoing a subsequent debridement for dehiscence (P ≤ .03). With a mean follow-up of 45.7 months, only 1 patient developed an asymptomatic parasacral hernia. CONCLUSION: Reconstruction of posterior sacrectomy defects with HADM and gluteus maximus myocutaneous flaps may be valid. This approach may have rates of wound dehiscence comparable to other techniques and low rates of parasacral herniation.",
keywords = "Chordoma, Gluteus maximus myocutaneous flap, Human acellular dermal matrix, Sacral hernia, Sacral reconstruction, Sacral tumors, Sacrectomy",
author = "Dasenbrock, {Hormuzdiyar H.} and Clarke, {Michelle J.} and Ali Bydon and Witham, {Timothy F} and Daniel Sciubba and Simmons, {Oliver P.} and Gokaslan, {Ziya L.} and Wolinsky, {Jean Paul}",
year = "2011",
month = "12",
doi = "10.1227/NEU.0b013e3182267a92",
language = "English (US)",
volume = "69",
pages = "1240--1247",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Reconstruction of extensive defects from posterior en bloc resection of sacral tumors with human acellular dermal matrix and gluteus maximus myocutaneous flaps

AU - Dasenbrock, Hormuzdiyar H.

AU - Clarke, Michelle J.

AU - Bydon, Ali

AU - Witham, Timothy F

AU - Sciubba, Daniel

AU - Simmons, Oliver P.

AU - Gokaslan, Ziya L.

AU - Wolinsky, Jean Paul

PY - 2011/12

Y1 - 2011/12

N2 - BACKGROUND: Performing a sacrectomy from an exclusively posterior approach allows the en bloc resection of tumors without the morbidity of a laparotomy. However, reconstruction of the resultant extensive soft-tissue defects is challenging because a vertical rectus abdominis myocutaneous flap is not harvested. OBJECTIVE: To report the largest series (with the longest follow-up) of sacral reconstructions using a combination of human acellular dermal matrix (HADM) and gluteus maximus myocutaneous flaps. METHODS: Thirty-four patients with sacral tumors with a follow-up of at least 1 year were reviewed retrospectively. After the tumor was excised, HADM (AlloDerm, LifeCell Corp, Branchburg, New Jersey) was secured to create a pelvic diaphragm. Subsequently, the gluteus maximus muscles were freed from their origins and advanced to cover the HADM. RESULTS: The mean age of patients was 50.1 years (SD, 16.0 years), and the histopathology was a chordoma in 82.4%. Seven patients (20.6%) developed a postoperative wound dehiscence, 5 of whom (14.7%) required operative debridement. An estimated blood loss of >1500 mL, an operative time of >9 hours during sacrectomy, and postoperative bowel incontinence were associated with a significantly higher likelihood of undergoing a subsequent debridement for dehiscence (P ≤ .03). With a mean follow-up of 45.7 months, only 1 patient developed an asymptomatic parasacral hernia. CONCLUSION: Reconstruction of posterior sacrectomy defects with HADM and gluteus maximus myocutaneous flaps may be valid. This approach may have rates of wound dehiscence comparable to other techniques and low rates of parasacral herniation.

AB - BACKGROUND: Performing a sacrectomy from an exclusively posterior approach allows the en bloc resection of tumors without the morbidity of a laparotomy. However, reconstruction of the resultant extensive soft-tissue defects is challenging because a vertical rectus abdominis myocutaneous flap is not harvested. OBJECTIVE: To report the largest series (with the longest follow-up) of sacral reconstructions using a combination of human acellular dermal matrix (HADM) and gluteus maximus myocutaneous flaps. METHODS: Thirty-four patients with sacral tumors with a follow-up of at least 1 year were reviewed retrospectively. After the tumor was excised, HADM (AlloDerm, LifeCell Corp, Branchburg, New Jersey) was secured to create a pelvic diaphragm. Subsequently, the gluteus maximus muscles were freed from their origins and advanced to cover the HADM. RESULTS: The mean age of patients was 50.1 years (SD, 16.0 years), and the histopathology was a chordoma in 82.4%. Seven patients (20.6%) developed a postoperative wound dehiscence, 5 of whom (14.7%) required operative debridement. An estimated blood loss of >1500 mL, an operative time of >9 hours during sacrectomy, and postoperative bowel incontinence were associated with a significantly higher likelihood of undergoing a subsequent debridement for dehiscence (P ≤ .03). With a mean follow-up of 45.7 months, only 1 patient developed an asymptomatic parasacral hernia. CONCLUSION: Reconstruction of posterior sacrectomy defects with HADM and gluteus maximus myocutaneous flaps may be valid. This approach may have rates of wound dehiscence comparable to other techniques and low rates of parasacral herniation.

KW - Chordoma

KW - Gluteus maximus myocutaneous flap

KW - Human acellular dermal matrix

KW - Sacral hernia

KW - Sacral reconstruction

KW - Sacral tumors

KW - Sacrectomy

UR - http://www.scopus.com/inward/record.url?scp=80955137463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80955137463&partnerID=8YFLogxK

U2 - 10.1227/NEU.0b013e3182267a92

DO - 10.1227/NEU.0b013e3182267a92

M3 - Article

C2 - 21637135

AN - SCOPUS:80955137463

VL - 69

SP - 1240

EP - 1247

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 6

ER -