Combination of a fillet flap, free tissue transfer, and autologous tissue grafts in pelvic reconstruction following retroperitoneal sarcoma: A case report

The resection of large pelvic tumors is challenging due to their infiltrative nature into multiple structures and organ systems. In this report, we describe the use of multiple vascularized and nonvascularized spare parts to reconstruct a pelvic defect in a patient with a uniquely large pelvic sarcoma invading the spinal canal. A 39-year-old Caucasian female who presented with a large retroperitoneal sarcoma where the tumor encased the left ureter, kidney, colon, and external iliac vessels and invaded the L3-S1 vertebral bodies. An extensive hemipelvectomy and reconstruction was performed over two days. A free thigh and leg fillet flap together with ipsilateral fibula flap, based on the superficial femoral artery and venae comitantes, was used for spinal reinforcement as well as abdominal and pelvic wall reconstruction. The postoperative course was uneventful without complications, no flap compromise or wound healing problems. After a followup period of 4 months, the patient had no complications and returned to activities of daily living with mild limitations. The success of this flap procedure shows the practicality and usefulness of using the full spectrum of tissue transfer for the purposes of a large pelvic reconstruction. V C 2014 Wiley Periodicals, Inc. Microsurgery 00:000‐000, 2014. Hemipelvectomies are morbid procedures often necessary to treat bone and soft tissue malignancies of the pelvis. The resection of large tumors invading the peritoneum are often challenging due to their infiltrative nature and frequent involvement of multiple structures and organ systems. In addition, the effects of neoadjuvant chemotherapy and radiation prior to surgery increase the likelihood of postoperative complications. Once resected, the goal of reconstruction is to provide soft tissue coverage of the defect to prevent herniation and evisceration of intra-abdominal organs, as well as bony reinforcement. The use of regional flaps provides a suitable solution, however, the use of tissue that would otherwise be discarded is optimal, described as the “spare-parts” principle. 1‐3 We describe the use of multiple vascularized and nonvascularized spare parts to reconstruct a pelvic defect in a patient with a uniquely large pelvic sarcoma invading the spinal canal. Case Report A 39-year-old Caucasian female presented with left groin pain associated with ambulation. Diagnostic