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10.1245/s10434-007-9672-5
Annals of Surgical Oncology 15:355-363 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Predictors of Complications and Outcomes of External Hemipelvectomy Wounds: Account of 160 Consecutive Cases

Alex Senchenkov, MD1, Steven L. Moran, MD1,2, Paul M. Petty, MD1, James Knoetgen, III, MD1, Ricky P. Clay, MD1, Uldis Bite, MD1, Sunni A. Barnes, PhD3 and Franklin H. Sim, MD2

1 Division of Plastic & Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
2 Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
3 Division of Biostatistics, Mayo College of Medicine, Health Sciences Research, Harwick Building 712, Rochester, Minnesota 55905, USA

Correspondence: Addresscorrespondence and reprint requests to: AlexSenchenkov, MD; E-mail: senchenkov{at}yahoo.com

Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity.

Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis.

Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy.

Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

Key Words: Hemipelvectomy • Operative technique • Pelvic vessel ligation • Wound infection • Flap necrosis • Pelvic reconstruction • Flaps • Pelvic wound complications




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