Multidisciplinary treatment of giant chondrosarcoma of the proximal femur by external hemipelvectomy and reconstruction with a pedunculated Fillet flap
presentation of a clinical
DOI:
https://doi.org/10.31837/cir.urug/6.1.16Keywords:
chondrosarcoma, bone neoplasms, reconstructive surgery}, soft tissue tumors, treatmentAbstract
Chondrosarcoma is one of the most frequent malignant primary tumors. Pelvic and proximal femur locations require extensive approaches with the consequent difficulty of soft tissue reconstruction. External hemipelvectomy is usually the procedure for these locations. It involves total en bloc resection of the lower extremity associated with ipsilateral hemipelvis, resulting in a large coverage defect. In some cases, local rotational flaps are impossible. Reconstruction with fillet flaps offers an adequate coverage for soft tissue defects. The objective of this study is to show the resolution of an unconventional case of chondrosarcoma of the proximal femur and its soft tissue reconstruction with a method never before used in our country.
Downloads
References
Bertoni F, Bacchini P. Classification of bone tumors. Eur J Radiol. 1998;27(Suppl 1):S74–6. Doi: 10.1016/s0720-048x(98)00046-1
Von Eisenhart-Rothe R, Toepfer A, Salzmann M, Schauwecker J, Gollwitzer H, Rechl H. Primary malignant bone tumors. Orthopade. 2011;40(12):1121–42. doi: 10.1007/s00132-011-1866-7.
Grimer RJ, Gosheger G, Taminiau A, Biau D, Matejovsky Z, Kollender Y, et al. Dedifferentiated chondrosarcoma: prognostic factors and outcome from a European group. Eur J Cancer. 2007; 43(14): 2060–5. doi: 10.1016/j.ejca.2007.06.016
Bjo?rnsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ. Primary chondrosarcoma of long bones and limb girdles. Cancer, 1998;83(10):2105–19.
Hogendoorn P, Bovee J, Nielsen G. Chondrosarcoma (grades I-III), including primary and secondary variants and periosteal chondrosarcoma. En: Fletcher C, Bridge J, Hogendoorn P, Mertens F (eds). WHO Classidication of Tumours of Soft Tissue and Bone. 4a. ed. IARC: Lyon, 2013:264-8
Welkerling H, Werner M, Delling G. Histologic grading of chondrosarcoma. A qualitative and quantitative analysis of 74 cases of the Hamburg bone tumor register. Pathologe. 1996;17(1):18–25. doi: 10.1007/s002920050130.
Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer.1977; 40(2):818–31. doi: 10.1002/1097-0142(197708)40:2<818::aid-cncr2820400234>3.0.co;2-b.
Kulaylat MN, Froix A, Karakousis CP. Blood supply of hemipelvectomy flaps: The anterior flap hemipelvectomy. Arch Surg 2001;136 (7): 828–31. doi: 10.1001/archsurg.136.7.828.
Bibbo C, Newman AS, Lackman RD, Levin LS, Kovach SJ. A simplified approach to reconstruction of hemipelvectomy de- fects with lower extremity free fillet flaps to minimize ischemia time. J Plast Reconstr Aesthet Surg 2015;68(12):1750–4. doi: 10.1016/j.bjps.2015.07.006.
Scaglioni. M, Lindenblatt. N, Barth. A, Fuchs B, Weder. W, Giovanoli. P. Free fillet flap application to cover forequarter or traumatic amputation of an upper extremity: A case report. Microsurgery. 2016; 36(8):700–4. doi: 10.1002/micr.30124.
Sánchez García A, Pérez García A, Salmerón González E, Thione A, García Vilariño E, Salom M, et al. The Spare Parts Concept in Sarcoma Surgery: A Systematic Review of Surgical Strategies. Inter J Orthoplastic Surg. 2019;2(3):90–8.
Kuntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg 2001; 108(4):885–96. doi: 10.1097/00006534-200109150-00011.
Ver Halen JP, Yu P, Skoracki RJ, Chang DW. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg. 2010;125(3):913?22. doi: 10.1097/PRS.0b013e3181cb6548.
Weaver JM, Flynn MB. Hemicorporectomy. J Surg Oncol. 2000;73(2): 117?124. doi: 10.1002/(sici)1096-9098(200002)73:2<117::aid-jso12>3.0.co;2-c.
Matthew R. Talarczyk, James H. Boehmler, Karin Ljungquist, Pankaj Tiwari, Joel L. Mayerson and Michael Miller. External Hemipelvectomy Pelvic Ring Stabilization: The Unique Application of Chimeric Lower Extremity Pedicled Fillet Flaps. J Reconstr Microsurg 2013;29:367–72. doi: 10.1055/s-0032-1333319.
Samant M, Chang EI, Petrungaro J, Ver Halen JP, Yu P, Skoracki RJ, et al. Reconstruction of massive oncologic defects following extremity amputation: a 10?year experience. Ann Plast Surg. 2012;68(5):467?71. doi: 10.1097/SAP.0b013e318232b096.
Kim JY, Subramanian V, Yousef A, Rogers BA, Robb GL, Chang DW. Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma. Plast Reconstr Surg. 2004;114(2): 400?8. doi: 10.1097/01.prs.0000131987.40578.7b.
Weinberg MJ, Al?Qattan MM, Mahoney J. “Spare part” forearm free flaps harvested from the amputated limb for coverage of amputation stumps. J Hand Surg 1997;22(5):615?9. doi: 10.1016/s0266-7681(97)80359-2
Russell RC, Vitale V, Zook EC. Extremity reconstruction using the “fillet of sole” flap. Ann Plast Surg. 1986;17(1):65?72. doi: 10.1097/00000637-198607000-00012
Kim JY, Ross MI, Butler CE. Reconstruction following radical resection of recurrent metastatic axillary melanoma. Plast Reconstr Surg 2006;117(5):1576?83. doi: 10.1097/01.prs.0000206305.37147.8d
Scott Levin L, Erdmann D, Germann G. The use of fillet flaps in upper extremity reconstruction. J Hand Surg 2002;2(1):39–44. doi: 10.1016/S1531-0914(02)80007-9
Morii T, Susa M, Nakayama R, Kishi K, Morioka H, Yabe H. Reconstruction modality based on the spare part concept for massive soft tissue defects following oncological hemipelvectomy. J Orthop Sci 2009;14(2):192–7. doi: 10.1007/s00776-008-1316-5
Flurry M, Melissinos EG, Livingston CK. Composite forearm free fillet flaps to preserve stump length following traumatic amputations of the upper extremity. Ann Plast Surg 2008;60(4):391?4. doi: 10.1097/SAP.0b013e31811ffe82.
Apffelstaedt JP, Driscoll DL, Spellman JE, Velez AF, Gibbs JF, Karakousis CP. Complications and outcome of external hemipelvectomy in the management of pelvic tumors. Ann Surg Oncol 1996;3(3):304–9. doi: 10.1007/BF02306287.
Senchenkov A, Moran SL, Pett PM, Knoetgen 3rd J, Tran NV, Clay RP, et al. Soft-tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg 2009;124(1):144–55. doi: 10.1097/PRS.0b013e3181a80557.
Kreutz-Rodrigues L, Weissler JM, Moran SL, Carlsen BT, Mardini S, Houdek MT, et al. Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthet Surg 2020;73(2):242-54. doi: 10.1016/j.bjps.2019.09.028.
Prewitt TW, Alexander HR, Sindelar WF. Hemipelvectomy for soft tissue sarcoma: clinical results in fifty-three patients. Surg Oncol 1995;4(5):261–9. doi: 10.1016/s0960-7404(10)80005-2.
Higinbotham NL, Marcove RC, Casson P. Hemipelvectomy: a clinical study of 100 cases with five-year-follow-up on 60 patients. Surgey 1966; 59(5):706–8.
Grimer RJ. Size matters for sarcomas! Ann R Coll Surg Engl 2006;88(6):519?24. doi: 10.1308/003588406X130651.
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles, videos and images published in Revista Cirugía del Uruguay are under the Creative Commons CC licenses, which is a complement to the traditional copyright, in the following terms: first, the authorship of the referred document must always be acknowledged and secondly none of the article or work published in the journal may have commercial purposes of any nature. The authors retain their copyrights and give the magazine the right of first publication of their work, which will be simultaneously subject to the Creative Commons Attribution-NonCommercial 4.0 International License license that allows the work to be shared whenever the initial publication is indicated in this journal.
