Soft-tissue reconstruction with pedicled vertical rectus abdominis myocutaneous flap after total or high sacrectomy for giant sacral tumor

Abstract

BackgroundThe large soft tissue defect after total or high sacrectomy for giant sacral tumor induces high incidence of wound complications. It remains a huge challenge to reconstruct the soft tissue defect with a preferred clinical outcome. MethodsA total of 27 patients undergoing one-stage total or high sacrectomy for giant sacral tumor between 2016 and 2021 in a tertiary university hospital were retrospectively reviewed. Thirteen patients underwent a pedicled vertical rectus abdominis myocutaneous (VRAM) flap reconstruction while 14 patients underwent a conventional wound closure. Patient’s clinical characteristics, surgical duration, postoperative complications and outcomes were compared between the two groups. ResultsPatients in VRAM and Non-VRAM group were similar in baseline characteristics. The mean tumor size was 12.85cm (range: 10~17cm) in VRAM group and 11.79cm (range: 10~14.5cm) in Non-VRAM group (P=0.139). The most common giant sacral tumor is chordoma. Patients in VRAM group had shorter length of drainage (9.85 vs 17.14 days), postoperative time in bed (5.54 vs 17.14 days), and total length of stay (19.46 vs 33.36 days) compared to patients in Non-VRAM group. Patients in VRAM group had less wound infection and debridement than patients in Non-VRAM group (15.4 vs 57.1%, P<0.001). ConclusionThis study demonstrates the advantages of pedicled VRAM flap reconstruction of large soft tissue defects after high or total sacrectomy when using the anterior-posterior approach. This choice of reconstruction is better than direct wound closure in terms of wound infection, length of drainage, and total length of stay.