Clinical results and quality of life after reconstruction following sacrectomy for primary bone malignancy

Publication date: Available online 24 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Juha Kiiski, Hannu O Kuokkanen, Minna Kääriäinen, Ilkka S Kaartinen, Toni-Karri Pakarinen, Minna K Laitinen

Summary

Background

Sacrectomy is a rare and demanding surgical procedure resulting in major soft tissue defects and spinopelvic discontinuity. No consensus is available on the optimal reconstruction algorithm. Therefore, the present study evaluated the results of sacrectomy reconstruction and its impact on patients' quality of life.

Methods

A retrospective chart review was conducted for 21 patients who underwent sacrectomy for a primary bone tumour. Patients were divided into groups based on the timing of reconstruction: no reconstruction, immediate reconstruction, or delayed reconstruction. Quality of life was measured using the EQ-5D instrument before and after surgery in patients treated in the intensive care unit.

Results

The mean patient age was 57 (range 22-81) years. The most common reconstruction was gluteal muscle flap (n=9) and gluteal fasciocutaneous flap (n=4). Four patients required free tissue transfer, three latissimus dorsi flaps and one vascular fibula bone transfer. No free flap losses were noted. The need for unplanned re-operations did not differ between groups (p=0.397) and no significant differences were found for pre- and post-operative quality of life or any of its dimensions.

Discussion

Free flap surgery is reliable for reconstructing the largest sacrectomy defects. Even in the most complex cases, surgery can be safely staged and final reconstruction carried out within 1 week of resection surgery without increasing peri-operative complications. Sacrectomy does not have an immoderate effect on the measured quality of life.