Internal Hemipelvectomy Research Articles

Internal hemipelvectomy in the management of pelvic Ewing sarcoma – are outcomes better than with radiation therapy?

BackgroundPelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function. Materials and methodsThirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000–2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT. ResultsTwenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol. ConclusionsInternal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.

Pelvic Resection

Pelvic resection is a technique that involves surgical resection of portions of the pelvic girdle. Historically, this procedure was known as internal hemipelvectomy. Hemipelvectomy is a resection that includes the ipsilateral limb. The main indication for these procedures is primary malignant tumors of the pelvis, but in rare cases they are indicated for metastatic lesions, infection, or trauma. Reconstruction is dictated by the extent of the resection and the remaining structures. Surgical technique is dictated by histology of the tumor and location of the lesion. A multidisciplinary team is required. The patient and family should undergo counseling preoperatively to discuss morbidity and mortality, the extensive rehabilitation process, and life expectancy.

Internal Hemipelvectomies: Resection and Reconstructive Options

Pelvic resections are technically difficult and complex procedures. This is because of the anatomy of the pelvic bone, the close proximity of pelvic viscera and vital neurovascular structures, and the usually large size of the tumors themselves. In addition, pelvic surgery often has significant psychological, visceral, and functional effects on the patient. Often referred to as a “heroic surgery,” several authors have questioned whether this “heroic surgery is justifiable.” They have found that despite the challenges faced by both the surgeon and the patient, evenwhen performed by experienced hands, pelvic resections result in high emotional acceptance and functional results, especially given the alternatives. Pelvic resections vary widely in size and shape, depending on the extent, nature, and location of the tumor. There are 2 types of hemipelvectomies; the “classic hemipelvectomy” or external hemipelvectomy (hind quarter amputation), and the limb sparing, internal hemipelvectomy. When considering a hemipelvectomy the questions that arise are, can the limb be salvaged and when is a hind quarter amputation recommended. If a partial pelvic resection does not allow for safe margins about the lesion or if the consequences of extirpation of the lesion are such that the residual limb is essentially functionless, a hind quarter amputation, or an external hemipelvectomy, is recommended. Anatomically speaking, the essential components needed to have a functional leg are the lumbosacral plexus, the femoral neurovascular bundle, and the hip joint. If any 2 of these 3 structures are resected along with the tumor, the resulting limb is useless, thus limb salvage, with internal hemipelvectomy, is not indicated and an external hemipelvectomy (hind quarter amputation) is recommended. However, when the tumor does not encompass these structures, an internal hemipelvectomy should be performed. Despite the difficulty in performing an internal hemipelvectomy or limb salvage, studies have shown that it can provide the patient with better functional results and improved quality

Biomechanical Study on the Novel Biomimetic Hemi Pelvis Prosthesis

A pelvic endoprosthesis is the primary means of pelvic reconstruction after internal hemipelvectomy. In this study, a novel biomimetic hemipelvic prosthesis, including an artificial ilium, an artificial acetabulum, and an artificial pubis, was developed. A Finite Element Method (FEM) was carried out to investigate the biomechanical performance of a pelvis reconstructed with biomimetic hemipelvic prosthesis. Two models, including the reconstructed pelvis and the original pelvis (control model), were established according to the geometry from CT data of a human male patient with pelvic bone sarcomas. The FE models predict that the biomechanical function of the pelvic ring can be reestablished using this prosthesis. Results show that the body force loaded on the S1 vertebra is restored and transferred towards the sacro-iliac joint, and along the ilium onto the bearing surface of the artificial ilium, then to the artificial acetabulum and pubis. Von Mises stresses observed in this reconstructed pelvis model are still within a low and elastic range below the yielding strength of cortical bone and Ti6Al4V. The values of deformation and strain of the reconstructed pelvis are close to the data obtained in the original pelvis. With the partial replacement of the pubis, little influence is found towards the pubis symphysis. However, the interface between the prosthesis and pelvic bone may become the critical part of the reconstructed pelvis due to the discontinuity in the material properties, which results in stress shielding and deformation constraining. So a biomimetic flexible connection or inter layer to release the deformation of pelvis is suggested in future designing.

Biological Reconstruction Following the Resection of Malignant Bone Tumors of the Pelvis

Background. Surgical treatment of malignant pelvic bone tumors can be very challenging. The objective of this retrospective study was to evaluate the oncological as well as the clinical and functional outcome after limb salvage surgery and biological reconstruction. Methods. The files of 27 patients with malignant pelvic bone tumors, who underwent surgical resection at our department between 2000 and 2011, were retrospectively analyzed (9 Ewing's sarcoma, 8 chondrosarcoma, 4 osteosarcoma, 1 synovial sarcoma, 1 malignant fibrous histiocytoma, and 4 carcinoma metastases). Results. After internal hemipelvectomy reconstruction was performed by hip transposition (n = 16), using autologous nonvascularised fibular graft (n = 5) or autologous iliac crest bone graft (n = 2). In one patient a proximal femor prothetis and in three patients a total hip prosthesis was implanted at the time of resection. The median follow-up was 33 months. Two- and five-year disease-specific survival rates of all patients were 86.1% and 57.7%, respectively. The mean functional MSTS score was 16.5 (~55%) for all patients. Conclusion. On the basis of the oncological as well as the clinical and functional outcome, biological reconstruction after internal hemipelvectomy seems to be a reliable technique for treating patients with a malignant pelvic bone tumor.

Single Stage Oncologic Resection and Reconstruction: A Step toward Development of Sarcoma Service in Resource Constrained Country

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection followed by flap coverage were identified. Lower limb reconstruction outnumbered upper limb by 6:1. Complications included, one complete failure of free vascularized iliac crest flap done for reconstruction of a heel defect. One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal hemipelvectomy for Ewing’s sarcoma had a dura puncture during resection of sacrum. Partial epidermal necrosis was evident in four cases. Eighty three percent of the patients remained alive (n = 20), 19 of whom currently have no evidence of disease (NED) Disease recurrence was noted in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is a reliable option that, though not free of complications, is necessary in selected cases. The procedure enables both adequate oncosurgical resection and function preservation.

En bloc resection of extra-peritoneal soft tissue neoplasms incorporating a type III internal hemipelvectomy: a novel approach

BackgroundA type III hemipelvectomy has been utilized for the resection of tumors arising from the superior or inferior pubic rami.MethodsIn eight patients, we incorporated a type III internal hemipelvectomy to achieve an en bloc R0 resection for tumors extending through the obturator foramen or into the ischiorectal fossa. The pelvic ring was reconstructed utilizing marlex mesh. This allowed for pelvic stability and abdominal wall reconstruction with obliteration of the obturator space to prevent herniations.ResultsAll eight patients had an R0 resection with an overall survival of 88% and with average follow up of 9.5 years. Functional evaluation utilizing the Enneking classification system, which evaluates motion, pain, stability and strength of the affected extremity, revealed a 62% excellent result and a 37% good result. No significant complications were associated with the operative procedure. Marlex mesh reconstruction provided pelvic stability and eliminated all hernial defects.ConclusionThe superior and inferior pubic rami provide a barrier to a resection for tumors that arise in the extra-peritoneal pelvis extending through the obturator foramen or ischiorectal fossa. Incorporating a type III internal hemipelvectomy with a simple marlex mesh reconstruction allows for complete tumor resection without functional compromise, acute infectious issues, obturator or abdominal hernia defects.

Incisional hernia of the urinary bladder following internal hemipelvectomy

INTRODUCTIONHemipelvectomies are uncommon operations, usually performed for primary or metastatic malignant disease and less frequently for benign-aggressive tumours. There are very few reports in literature regarding complications of these procedures and even fewer reports about post hemipelvectomy hernias in particular. PRESENTATION OF CASEWe present the only reported case of an incisional hernia of the urinary bladder following internal hemipelvectomy for aneurysmal bone cyst of the pubic bone. A careful literature review is also performed. DISCUSSIONThe development of the incisional hernia in the case of our patient can most likely be explained by the absence of advanced malignant disease of the pelvis that not only reduces the life expectancy but also overshadows other complications post hemipelvectomy. Furthermore, her young age and level of fitness allowed for a full postoperative rehabilitation which, combined with the proven anatomical changes of the internal organs following hemipelvectomies and the weakening of the tissues around the operative site, predisposed to the hernia formation. CONCLUSIONHemipelvectomies are extensive, anatomically disruptive operations, with significant detriment to the psychosomatic well being of the patients. We presented the only reported case of incisional hernia of the urinary bladder following internal hemipelvectomy and our reconstructive method of choice. We believe that, in the case of our patient, if a mesh had been used to reconstruct the primary defect during the initial surgery, this complication could have been prevented.

Internal and External Hemipelvectomy or Flail Hip in Patients with Sarcomas

We evaluated the quality-of-life of patients who have had an internal hemipelvectomy with and without (flail hip) prosthetic reconstruction and external hemipelvectomy. We reviewed the cases of 15 patients who had undergone either internal or external hemipelvectomy for tumor. Fifteen patients who were previously treated operatively with either a type II periacetabular internal (n = 5) or external (n = 10) hemipelvectomy were evaluated using the Toronto Extremity Salvage Score (TESS), Musculoskeletal Tumor Society (MSTS), and the 36-item Short-Form Health Survey. There were 11 (73%) men and 4 (27%) women in the study, with a mean age at operation of 46.9 ± 18.0 yrs (range, 18-69 yrs). Follow-up was 30.6 ± 19.6 mos (range, 6-70 mos). Overall mean MSTS score was 45.2 (range, 6.7 to 83.3), and TESS score was 60.4 ± 16.1 (range, 31.8-88.0). The 36-item Short-Form Health Survey physical component score results were lower than the general population. TESS and MSTS were all positively correlated to physical component score. There were no significant influences of postsurgery time on MSTS, TESS, or physical component score. Age had a negative correlation with physical function. Quality-of-life and functional outcome were significantly reduced for patients with internal and external hemipelvectomies on the TESS, MSTS, and the 36-item Short-Form Health Survey physical component scores.

Poster 389 Internal Hemipelvectomy After Osteomyelitis in an Adolescent: A Case Report

PM&RVolume 3, Issue 10S1 p. S309-S309 2011 AAPM&R Annual Assembly Abstract Poster 389 Internal Hemipelvectomy After Osteomyelitis in an Adolescent: A Case Report Clarice Sinn DO, Clarice Sinn DO University of Kansas, Kansas City, KS, United StatesSearch for more papers by this authorAnn C. Modrcin MD, Ann C. Modrcin MD University of Kansas, Kansas City, KS, United StatesSearch for more papers by this authorMark Sinclair MD, Mark Sinclair MD University of Kansas, Kansas City, KS, United StatesSearch for more papers by this author Clarice Sinn DO, Clarice Sinn DO University of Kansas, Kansas City, KS, United StatesSearch for more papers by this authorAnn C. Modrcin MD, Ann C. Modrcin MD University of Kansas, Kansas City, KS, United StatesSearch for more papers by this authorMark Sinclair MD, Mark Sinclair MD University of Kansas, Kansas City, KS, United StatesSearch for more papers by this author First published: 22 October 2011 https://doi.org/10.1016/j.pmrj.2011.08.418Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume3, Issue10S1September 2011Pages S309-S309 RelatedInformation

Surgical outcomes for 187 patients with locally recurrent rectal cancer and analysis of prognostic factors

To evaluate the surgical outcomes for patients with locally recurrent rectal cancer (LRRC) and to analyze the prognostic factors. Clinical data of 187 patients with LRRC undergoing surgery at the First Hospital of peking University from January 1985 to December 2009 were retrospectively reviewed. Procedures performed included local resection(n=34), abdominoperineal resection (n=35), posterior pelvic exenteration (n=17), total pelvic exenteration(TPE, n=98), TPE with sacrectomy (n=2), and TPE with internal hemipelvectomy (n=1). The operation was R0 in 87 patients, R1 in 60, and R2 in 40. The degree of radical resection was associated with the initial surgery and the degree of pelvic fixation (P<0.05). The pelvic recurrence rate was 44.4%(64/144). The operative morbidity and mortality were 47.5%(89/187) and 2.7%(5/187), respectively. The overall 3- and 5-year survival rates were 42.2% and 30.7%, respectively. The degree of radical resection and lymph node metastasis were independent risk factors associated with prognosis. The 5-year survival rates of R0, R1 and R2 were 42.6%, 17.2% and 0, respectively(P<0.01). The 5-year survival rates of patients with and without lymph node metastasis were 5.6% and 40.5%(P<0.01) respectively. Accurate evaluation of extent of pelvic fixation and achievement of R0 resection are critical to improve the surgical outcomes for LRRC.

Clinical Effectiveness of Hemipelvic Reconstruction Using Computer-Aided Custom-Made Prostheses After Resection of Malignant Pelvic Tumors

This is a retrospective analysis of 16 patients with primary malignant pelvic tumors who underwent wide resection of the hemipelvis and consequent reconstruction between 2003 and 2007. Mean patient age was 27 years, whereas median follow-up was 36 months (range, 23-62 months). Hemipelvic prostheses were individually designed for each patient based on preoperative computed tomographic scans and consequent surgical modeling. The 3-year prosthesis survival rate was 69%. There were 3 cases of local recurrence (19%), and 4 patients died because of pulmonary metastases. The mean follow-up Musculoskeletal Tumor Society functional score was 72%. In conclusion, computer-aided custom-made hemipelvic prosthesis can be applied to quickly and effectively restore the bone defect after internal hemipelvectomy for treatment of pelvic tumors.

Comparison of Postoperative Rehabilitation in Cancer Patients Undergoing Internal and External Hemipelvectomy

Guo Y, Fu J, Palmer JL, Hanohano J, Cote C, Bruera E. Comparison of postoperative rehabilitation in cancer patients undergoing internal and external hemipelvectomy. Objective To compare postoperative rehabilitation, functional outcome, and pain management in cancer patients who underwent an internal hemipelvectomy versus an external hemipelvectomy. Design Retrospective study. Setting Tertiary cancer center. Participants Patients (N=60) who underwent a hemipelvectomy between February 1996 and November 2005 were included in this study (30 internal hemipelvectomy patients and 30 external hemipelvectomy patients). Interventions Not applicable. Main Outcome Measures Hospital and rehabilitation length of stay (LOS), percentage of physiatrist consultation and inpatient rehabilitation, functional status of transfers and ambulation, and pain medication utilization. Results The rate of physiatrist consultation and acute rehabilitation admission were 15 (50%) of 30 and 13 (43%) of 30 for internal hemipelvectomy patients, and 16 (53%) of 30 and 16 (53%) of 30 for external hemipelvectomy patients. Median hospital LOS for external hemipelvectomy patients (37d) was significantly longer than for internal hemipelvectomy patients (19d) ( P=0.004); median rehabilitation LOS was similar in both groups (20d for external hemipelvectomy patients versus 22 for internal hemipelvectomy patients; P=0.83). On discharge, 14 (47%) of 30 internal hemipelvectomy patients could ambulate without assistance, whereas only 5 (17%) of 30 external hemipelvectomy patients could do so ( P=0.013). The median morphine equivalent daily dose at discharge for external hemipelvectomy patients (150mg) was significantly higher than that for internal hemipelvectomy patients (45mg) ( P=0.032). Conclusions A similar percentage of internal hemipelvectomy and external hemipelvectomy patients were admitted to inpatient rehabilitation. External hemipelvectomy patients had longer hospital LOS, less favorable functional outcome, and required more intense treatment for pain.

Internal Hemipelvectomy for Musculoskeletal Tumors—Indications and Options for Reconstruction

Resection of all or part of the bony pelvis is commonly referred to as internal hemipelvectomy. This procedure is a common treatment for various localized primary tumors of the hemipelvis, and rarely for metastatic lesions. Options for reconstruction following tumor resection include allograft, allograft-prosthetic composite (APC), and endoprosthetic reconstruction. An alternative method of limb salvage following resection of the hemipelvis is resection arthroplasty. Controversy exists among musculoskeletal oncologists regarding the most durable and functional method of reconstruction. As primary musculoskeletal tumors involving the pelvis are rare, there are few well-designed studies from which to draw definitive conclusions. The purpose of this paper is to review the indications for internal hemipelvectomy and to examine the risks and benefits of the available reconstruction methods.

Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos

OBJETIVO: Demonstrar a experiência de uma única instituição em hemipelvectomias internas sem reconstrução. Avaliar as cirurgias pélvicas preservadoras e as amputações interílio-abdominais e seu prognóstico. MÉTODOS: 21 pacientes com tumores primitivos pélvicos submetidos à hemipelvectomia com ou sem preservação de membro. Sete foram tratados com hemipelvectomias externas (amputação) e 14 com internas, entre junho de 2004 e julho de 2009. A classificação cirúrgica utilizada foi a de Enneking para tumores pélvicos. O método de avaliação funcional foi o escore de ISOLS/MSTS. RESULTADOS: A sobrevida dos pacientes em dois anos foi de 63,9%. A média de sobrevida do grupo todo foi de 43 meses. A avaliação funcional demonstrou que as hemipelvectomias preservadoras com ressecção do osso inominado obtiveram 12,5%, 62,5% e 25% de resultados ruins, bons e excelentes, respectivamente. Nos casos em que o osso inominado foi preservado, os resultados foram 16,7% e 83,3% bons e excelentes, respectivamente. CONCLUSÕES: A hemipelvectomia é procedimento pouco usual e causador de importante limitação funcional e comorbidades. A alternativa de ressecar a hemipelve sem reconstrução tem demonstrado resultados tão bons quanto a não-reconstrução. Os elevados custos médicos, além das possíveis complicações com uso de enxerto e próteses justificam a técnica empregada neste artigo. Nível de Evidência IV, Estudo de caso-controle.

HEMIPELVECTOMY: ERASTO GAERTNER HOSPITAL'S EXPERIENCES WITH 32 CASES IN 10 YEARS

Objective: To show the experience of the Erasto Gaertner Hospital with hemipelvectomy surgery over a 10-year period. Methods: This was a retrospective study on 32 patients who underwent hemipelvectomy at Erasto Gaertner Hospital between 1998 and 2008, assessing clinical and surgical characteristics. Results: Among the 32 patients, 15 were female and 17 were male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: three were located in the iliac and extended to the thigh, two were in the acetabulum and extended to the thigh and three were in the acetabulum and pubis. Twenty-three cases presented a neurovascular bundle free from neoplasia: 11 were restricted to the iliac, six were in the acetabular region, two were in the pubic ramus and four extended to the whole hemipelvis bone. One case involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and four cases of Ewing's sarcoma represented the majority. Eight cases underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; four were type II; two were type II + III; three were type III and four were type IV). Of these 24 cases, 13 did not have any reconstruction, 10 had a fibular graft and one had an iliacfemoral vein and artery prosthesis. Twenty-six surgeries were curative and six were palliative. There were 14 deaths. Survival of two and five years was seen in 11 and 10 cases, respectively. For six cases, less than two years had passed since the operation. Three cases were lost during follow-up. Conclusion: This study shows the experiences of an oncology reference service specializing in highly complex surgical treatment.

The non-vascularised fibular graft

Internal hemipelvectomy is a standard treatment for malignant tumours of the pelvis. Reconstruction using a non-vascularised fibular graft is relatively straightforward compared to other techniques. We describe the surgical and functional outcomes for a series of ten patients who underwent an internal hemipelvectomy (type I or I/IV) with reconstruction by a non-vascularised fibular graft between 1996 and 2009. A key prerequisite for this procedure was a preserved sciatic notch, confirmed pre-operatively on MRI. Graft-host union was achieved in all patients with a single fibular graft, and in the lower graft where two grafts had been used. The mean time to union was 7.3 months (3 to 12). The upper graft did not unite in four of six cases where two grafts had been used. Seven patients were eventually able to walk without a stick. The mean post-operative Musculoskeletal Tumour Society score was 75.4% (16.7 to 96.7). There were no cases of deep post-operative infection. The mean pelvic shortening was 0.9 cm (0.2 to 3.4). Recurrent tumour occurred in three cases, and death from tumour-related disease occured in one. Patients who need an internal hemipelvectomy will do well if their pelvic ring is reconstructed with a non-vascularised fibular graft. The complication rate is low, and they attain a good functional outcome.

The use of CT derived solid modelling of the pelvis in planning cancer resections

Clinical problem Resection of malignant tumors of the pelvis is demanding. To avoid disabling hemipelvectomies, years ago internal hemipelvectomy combined with partial pelvic replacements had become a surgical procedure. To achieve adequate reconstructions custom-made replacements were recommended. In early stages of the surgical procedure using megaprostheses, individual pelvic models were manufactured. Aim of the study Since little is known about the accuracy of such models we analysed the charts of 24 patients (25 models) for whom an individual model of the osseous pelvis had been manufactured. Results Two patients refused surgery. In 23 patients partial resection of the bony pelvis was performed followed by a partial pelvic replacement (13×), hip transposition procedure (5×), ilio-sacral resection (4×), or revision surgery. In all patients who received a partial pelvic replacement, the fit of the replacement was optimal. No major unplanned resection was necessary. The same was observed in patients who received a hip transposition procedure or an ilio-sacral resection. Oncologically, in most of the patients we achieved wide resection margins (14×). In 5 patients the margins were marginal (4×) or intralesional (1×). In two cases the aim was a palliative resection because of a metastatic disease (1×) or benign entity (1×). Conclusion Pelvic models are helpful tools to planning the manufacture of partial pelvic replacements and ensuring optimal osseous resection of the involved bone. Further attempts have to be made to evaluate the aim of navigational techniques regarding the accuracy of the osseous and soft-tissue resection.

Fibula Free Flap Reconstruction of the Pelvisin Children after Limb-Sparing Internal Hemipelvectomy for Bone Sarcoma

Neoadjuvant chemotherapy has improved the treatment of bone sarcomas, making wide resection with limb salvage frequently possible. However, resection of iliac tumors without reconstruction causes pelvic instability and significant leg length discrepancy. Free vascularized bone autograft reconstruction represents a potentially optimal method for iliac reconstruction because of the faster healing time and rapid hypertrophy of the grafts. Furthermore, living incorporated autograft may be more durable in the setting of radiation therapy or chemotherapy. The purpose of this study was to characterize the successful reconstruction of the pelvis in children using a triangular double-barrel fibula free flap following limb-sparing internal hemipelvectomy for sarcoma. A retrospective review of the operative records and patient charts was performed with identification of patient characteristics, operative details, postoperative outcomes, complications, and need for additional procedures. Four patients were identified who underwent fibula free flap reconstruction of the hemipelvis following type I resection with preservation of the hip joint. The mean age of the patients was 13.4 years, with a mean follow-up of 7.2 years. Flap survival was 100 percent, no postoperative infections occurred, and there were no local recurrences. All four patients returned to independent ambulation. The female patient was ultimately able to bear two children. One patient required epiphysiodesis for leg length discrepancy. An "A-frame" double-barrel fibula free flap can be used effectively for reconstruction of the type I internal hemipelvectomy defect. It permits a return to ambulation and minimizes leg length discrepancy and other complications, which may be critical in the immature pediatric skeleton.

Application of the ICF Model in the Acute Care Physical Therapy Management of a Young Man with Pelvic Chondrosarcoma following Internal Hemipelvectomy: A Case Report

Application of the ICF Model in the Acute Care Physical Therapy Management of a Young Man with Pelvic Chondrosarcoma following Internal Hemipelvectomy: A Case Report