Tratamiento multidisciplinario de condrosarcoma gigante de fémur proximal mediante hemipelvectomía externa y reconstrucción con colgajo pediculado tipo fillet flap: presentación de un caso clínico / Multidisciplinary treatment of giant chondrosarcoma of the proximal femur by external hemipelvectomy and reconstruction with a pedunculated fillet flap: presentation of a clinical case / Tratamento multidisciplinar do condrossarcoma gigante do fêmur proximal por hemipelvectomia externa e reconstrução com retalho fillet flap: apresentação de um caso clínico

El condrosarcoma forma parte de los tumores primarios malignos más frecuentes. Las localizaciones pélvicas y de raíz de muslo requerirán abordajes amplios con la consecuente dificultad de cobertura de partes blandas. La hemipelvectomía externa es habitualmente el procedimiento de elección para estas localizaciones. Implica la resección de la extremidad inferior en bloque asociada a la hemipelvis ipsilateral, dando como resultado un gran defecto de cobertura. En algunas circunstancias, la extensa resección de partes blandas hace imposible la utilización de colgajos rotacionales locales. La reconstrucción con colgajo tipo "Fillet flaps" ofrece a estos defectos de partes blandas la opción de lograr una adecuada cobertura. El objetivo del trabajo es mostrar la resolución de un caso poco convencional de condrosarcoma de fémur proximal y su reconstrucción de partes blandas con un método nunca antes utilizado en nuestro medio.

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.

O condrossarcoma é um dos tumores primários malignos mais frequentes. As localizações das raízes pélvicas e da coxa exigirão amplas abordagens com a conseqüente dificuldade em cobrir os tecidos moles. A hemipelvectomia externa costuma ser o procedimento de escolha para esses locais. Envolve a ressecção do membro inferior em bloco associado à hemipelve ipsilateral, resultando em um grande defeito de cobertura. Em algumas circunstâncias, a ressecção extensa de partes moles impossibilita o uso de retalhos rotacionais locais. A reconstrução com retalhos de filé oferece a esses defeitos de tecidos moles a opção de obter uma cobertura adequada. O objetivo deste trabalho é mostrar a resolução de um caso não convencional de condrossarcoma do fêmur proximal e sua reconstrução de partes moles com método nunca antes utilizado em nosso meio.

Hemicorporectomía y equipamiento protésico. Reporte de un caso a los 15 años de seguimiento / Hemicorporectomy and prosthetic equipment. Report of a case at 15 years of follow-up

La hemicorporectomía o amputación translumbar es una cirugía radical indicada en casos de tumores, osteomielitis crónicas y traumas graves de la pelvis, y también, en pacientes parapléjicos con úlceras por decúbito intratables. La tasa de mortalidad por este procedimiento es del 50% y la gran mayoría de los pacientes que sobreviven quedan confinados a una silla de ruedas. El equipamiento de todo el hemicuerpo inferior es sumamente complejo. Comunicamos el caso de un paciente con una hemicorporectomía, secuela de una osteomielitis pélvica, su equipamiento completo posterior y su evolución a los 15 años de seguimiento. Nivel de Evidencia: IV

Hemicorporectomy or translumbar amputation is a radical surgery indicated in localized pelvic tumors, chronic osteomyelitis, severe trauma, and intractable decubitus ulcers in paraplegic patients. It has a death rate of about 50% and most of the patients are confined to a wheelchair. The equipment of the entire lower body is extremely complex. We report a case of a patient with a hemicorporectomy, sequel to pelvic osteomyelitis, his subsequent complete equipment, and his evolution after 15 years of follow-up. Level of Evidence: IV

Epidemiological characteristics of patients with pelvic tumors submitted to surgical treatment / Características epidemiológicas dos pacientes com tumores pélvicos submetidos a tratamento cirúrgico

ABSTRACT Objective: Describe the epidemiological profile of patients with primary or secondary neoplastic lesions in the pelvis who required a surgical procedure such as hemipelvectomy. Methods: This study retrospectively evaluated 69 patients located in the database of a São Paulo educational institution, subject to surgical hemipelvectomy treatment between January 1990 and December 2013. All patients had previous diagnosis of bone tumor (primary or metastatic) in the pelvis (ilium, ischium, pubis, and/or sacrum). Results: Analyzing the data obtained in this study, it was observed that these are partly similar to those found in the literature, with primary bone malignancies as the main diagnosis; general injuries affecting the pelvic area I (pelvic bone) and its most frequent complication, infection. The differences are mainly due to rarity of the bone tumors evaluated in this study, and the type of surgical procedure in question, which is even more unusual. Conclusion: Building a picture that conveys the reality of each diagnosis and that indicates which characteristics of these patients would better resemble an absolute or relative indication for the realization of hemipelvectomy is harder by the rarity of these cases.

RESUMO Objetivo: Traçar o perfil epidemiológico dos pacientes com lesões neoplásicas na pelve, primárias ou secundárias, para as quais foi necessário procedimento cirúrgico do tipo hemipelvectomia. Métodos: Foram avaliados, retrospectivamente, 69 pacientes localizados no banco de dados de uma instituição de ensino de São Paulo, submetidos a tratamento cirúrgico tipo hemipelvectomia entre janeiro de 1990 e dezembro de 2013. Todos os pacientes apresentavam diagnóstico prévio de tumor ósseo (primário ou metastático) na pelve (ílio, ísquio, púbis e/ou sacro). Resultados: Ao analisar os dados obtidos no presente estudo, observou-se que esses são em parte semelhantes aos encontrados na literatura mundial, apresentam como principal diagnóstico as neoplasias malignas ósseas primárias. Em geral, as lesões acometeram a zona I pélvica (osso ilíaco) e a complicação mais frequentemente observada foi a infecção. As diferenças encontradas são devidas principalmente à raridade dos tumores ósseos avaliados nesses estudos e ao tipo de procedimento cirúrgico em questão, esses ainda mais incomuns. Conclusão: Construir um panorama que transmita a realidade de cada diagnóstico e indique quais as características que esses pacientes apresentam que mais se aproximariam como indicações relativas ou absolutas para o procedimento de hemipelvectomia encontra na raridade desses casos o seu maior obstáculo.

Partial internal hemipelvectomy as rescue therapy in obstipation in four dogs: case report / Hemipelvectomia caudal parcial interna como terapia de salvamento na obstipação em quatro cães: relato de caso

Multiple pelvic fractures can lead to narrowing of the pelvic canal and loss of life quality. Hemipelvectomy, characterized by removal of bone fragments from the pelvis, is considered a rescue therapy. This report describes the technique of caudal partial hemipelvectomy in four cases of obstipation secondary to traumatic pelvic canal narrowing in four dogs, with promising results. All patients had tenesmus and fecal retention. After the procedure, the patients presented immediate normochezia and support of the ipsilateral limb after 10 to 20 days, showing the feasibility of the technique in small animals, providing clinical improvement without walking alterations.(AU)

Múltiplas fraturas da pelve podem gerar angústia pélvica. A hemipelvectomia, caracterizada pela remoção de fragmentos ósseos da pelve, é considerada terapia de salvamento. O presente relato descreve a técnica de hemipelvectomia interna parcial em quatro casos de obstipação por angústia pélvica traumática em cães, com resultados alvissareiros. Todos os pacientes apresentavam tenesmo e retenção fecal. Após a realização do procedimento, os pacientes apresentaram normoquesia imediata e apoio do membro ipsilateral ao procedimento após 10 a 20 dias, mostrando a exequibilidade da técnica em animais leves, uma vez que houve melhora clínica sem alterações na deambulação.(AU)

Hemipelvectomy with laparoscopic abdominoperineal excision for epithelioid sarcoma treatment / Hemipelvectomia com amputação laparoscópica do reto para tratamento de sarcoma epitelioide

Abstract The epithelioid sarcoma (ES) is an unusual variant of the sarcoma, not reaching 1% of all soft tissue sarcomas. Initially reported in 1970, it has a more aggressive variant, which was classified as the "proximal-type" in 1997. These are aggressive tumors with high rates of distant metastasis and local relapses. Isolated radio and chemotherapy responses are poor and free-margin surgical resection is the treatment of choice.This is the case report of a 25-year-old male patient diagnosed with "proximal-type" ES in the perineal region. He underwent surgical resection in another institution and was later admitted to our institution with local recurrence with rectal and left thigh muscle invasion. Neoadjuvant radio-chemotherapy was performed, followed by laparoscopic abdominoperineal rectal resection and partial left hemipelvectomy associated with left lower-limb amputation. The patient had no postoperative complications and is currently undergoing outpatient follow-up. The anatomopathological analysis showed tumor-free margins.The "proximal-type" ES is a rare soft-tissue sarcoma subtype. High local recurrence, as well as the metastasis rates, makes its treatment a challenging task.

Resumo O sarcoma epitelióide (SE) é um subtipo incomum de sarcoma, não chegando a 1% dos sarcomas de partes moles. Foi inicialmente descrito em 1970, sendo que em 1997 uma variante mais agressiva foi classificada como "tipo proximal". São tumores agressivos, com altas taxas de metástases e recidiva local, com resposta pobre à quimioterapia e radioterapia isoladas. A ressecção cirúrgica com margens livres é o tratamento padrão.Apresentamos o caso de um paciente de 25 anos com SE tipo proximal avançado em região perineal, submetido a ressecção em outro serviço, evoluindo com recidiva local com invasão do canal anal e musculatura da coxa esquerda. Foi realizado tratamento radioquimioterápico neoadjuvante seguido de ressecção cirúrgica com amputação abdominoperineal do reto por videolaparoscopia associada a hemipelvectomia parcial esquerda incluindo o membro inferior esquerdo (MIE). O paciente apresentou boa evolução pós operatória e encontra-se em segmento ambulatorial. O anatomopatológico evidenciou margens cirúrgicas livres.O SE proximal é um tipo raro de sarcoma de partes moles, cujo tratamento curativo é desafiador, em virtude dos altos índices de recidiva local e metástases à distância.

Colgajo anterior de muslo en hemipelvectomía externa, reporte de caso / Anterior fl ap on external hemipelvectomy, case report

Introducción. La hemipelvectomía es un procedimiento agresivo para el tratamiento de tumores localmente avanzados. Requiere la conformación de un equipo interdisciplinario. Las opciones de cobertura dependen de la topografía de la lesión, existiendo 3 tipos de colgajo: posterior, anterior, y libre. Material y método. Se presenta el caso clínico de un paciente que presentó una ulcera de Marjolin a nivel de región trocantérica y glútea derecha, en el que se realizó una hemipelvectomía externa extendida, asociada a un colgajo anterior de muslo. Se trató de un colgajo músculo-cutáneo pediculado a los vasos femorales superfi ciales y profundos, compuesto por todos los planos de la logia anterior de muslo. Resultados. En este paciente se alcanzó una adecuada cobertura del defecto, que permitió su pronta rehabilitación. Discusión. Este colgajo es descripto como un colgajo pediculado en los vasos femorales superfi ciales. Creemos que si bien presenta vascularización por estos vasos, su mayor vascularización está dada por la arteria femoral profunda y su rama lateral circunfl eja. Este colgajo permite una adecuada cobertura en lesiones posteriores, con buena calidad de cobertura y menor número de complicaciones que el colgajo posterior. Conclusión. La hemipelevectomía externa es un tratamiento agresivo realizado para lesiones localmente avanzadas, con alta morbimortalidad, y que debe ser realizada por un equipo interdisciplinario. En cuanto a la cobertura, el colgajo anterior presenta buenos resultados dada su buena vascularización.

Background. Hemipelvectomy is an aggressive procedure for the treatment of locally advanced tumors. It requires the formation of an interdisciplinary team. The coverage options depend on the topography of the lesion, being 3 types of fl aps: posterior, anterior, and free. Material and Method. We present a case of a patient presenting an ulcer of Marjolin at the right trochanteric region. In which an extended external hemipelvectomy anterior fl ap is performed. It is a muscle cutaneous fl ap pediculated to the superfi cial and deep femoral vessels, composed of all the planes of the anterior thigh lodge. Results. In our patient we have reached an adequate coverage of the defect, which allowed an early rehabilitation of the patient. Discussion. This fl ap is described as a pedicled fl ap in the superfi cial femoral vessels. We believe that this fl ap is vascularized by these vessels, but its major vascularization is given by the deep femoral artery and its circumfl ex lateral branch. This fl ap allows adequate coverage in posterior lesions, with a good quality of coverage, and a lower number of complications than the posterior fl ap. Comments. External hemipelvectomy is an aggressive treatment performed for locally advanced lesions, with high morbidity and mortality, which must be performed by an interdisciplinary team. Regarding the coverage, we highlight the good results achieved by this fl ap given its good vascularization.

Surgical and Oncological Outcome of Pelvis Bone Tumor Patients with Type III Internal Hemipelvectomy / 대한정형외과학회잡지

PURPOSE: It is generally accepted that bony reconstruction after type III (pubic) internal pelvectomy is not necessary. However, technical problems in type III resection, functional outcome according to the extent of resection, and the usefulness of synthetic material to decrease the risk of hernia has not been well addressed. MATERIALS AND METHODS: Fifteen patients who underwent type III internal pelvectomy were extracted and the pathologic diagnosis, Enneking's stage, location of tumor and size, operation time, amount of transfusion, surgical margin, local recurrence, distant metastasis, and functional outcomes were analyzed according to the extent of resection. RESULTS: Pathologic diagnosis was chondrosarcoma in 9, Ewing's sarcoma in 3, metastatic carcinoma in 2, and osteosarcoma in 1 patient. There were 4 patients with local recurrence and one with concomitant lung metastasis. Average Musculoskeletal Tumor Society functional score was 26.7. According to the extent of resection, functional score of 7 cases with unilateral both rami (6) or ischium (1) resection was 26, 4 cases with unilateral both rami and partial contralateral pubic ramus resection was 25, and 4 cases with unilateral both rami including ischium was 24. Two patients had tumor related complication. One patient with a huge intrapelvic tumor aroused at the symphysis pubis showed urethral invasion at presentation, therefore, urethral resection and permanent suprapubic cystostomy was inevitable. The other patient with bilateral pubic ramus involvement by tumor showed caudal displacement of the uterus after pregnancy (4 years after primary resection). She underwent Caesearian section for delivery. CONCLUSION: Regardless of the extent of pubic bone resection, functional outcome was similar. The risk of abdominal or pelvic organ hernia was minimal even without the use of artificial material for soft tissue reconstruction; however, when the extent of resection crosses the symphysis pubis, selective application of an additional procedure to reinforce the pelvic floor may be considered.

Reconstrução após ressecção extensa de tumor das cinturas pélvica e escapular: relato de dois casos / Reconstruction following extensive tumor resection of the pelvic and scapular girdle: a report of two cases

As cirurgias radicais para tratamento dos tumores da cintura pélvica e escapular (hemipelvectomias e desarticulações interescapulotorácicas) constituem-se, em geral, em procedimentos extensos com grandes áreas de perda de substância local após ressecção do tumor. A utilização do retalho que inclui toda a musculatura anterior e posterior da coxa após dissecção do fêmur, pediculado pelos vasos femorais superficiais, foi descrita apenas uma vez na literatura. O retalho similar utilizando toda a musculatura anterior e posterior do braço após dissecção do úmero, pediculado pelos vasos subclávios para reconstrução após desarticulação interescapulotorácica, não apresenta relatos. Descrevemos dois casos - um de hemipelvectomia e outro de desarticulação interescapulotorácica - utilizando estes dois retalhos para fechamento do defeito.

Radical surgeries for treatment of scapular and pelvic girdle tumors (hemipelvectomy and interscapulothoracic amputation) are generally extended procedures, with large areas of local tissue loss after tumor resection. The use of a flap that includes all the anterior and posterior thigh musculature after femur dissection, pedicled in the superficial femoral vessels, has been described was only once in the medical literature, and there have been no reports on a similar flap using the whole anterior and posterior musculature of the arm after humerus dissection, pedicled in the subclavian vessels, for reconstruction after interscapulothoracic amputation. Here, we describe two cases - one hemipelvectomy and one interscapulothoracicl amputation - using these two the flaps to close the defect.

Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos / Hemipelvectomies: treatment, functional outcome and prognostic of the pelvic tumors

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 por cento. 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 por cento, 62,5 por cento e 25 por cento de resultados ruins, bons e excelentes, respectivamente. Nos casos em que o osso inominado foi preservado, os resultados foram 16,7 por cento e 83,3 por cento 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.

OBJECTIVE: To describe the experience of one single institution in internal hemipelvectomies without reconstruction and external hemipelvectomies. METHODS: Twenty-one patients with primary tumors of the pelvic region underwent total hemipelvectomy, at Barretos Cancer Hospital, São Paulo, Brazil, between 2004 and July 2009. Of these, seven were treated with external hemipelvectomy (classic) and 14 with internal hemipelvectomy. Evaluation was done based on Enneking's surgical classification for internal hemipelvectomy. RESULTS: Overal survival in two years was 63,9 percent. Median survival of 43 months. Functional outcomes demonstrated that procedures with inominate bone ressection reached 12,5 percent, 62,5 percent and 25 percent of bad, good and excellent results, respectively. When inominate bone was preserved the results were 16,7 percent and 83,3 percent good and excellent, respectively. No endoprosthesis or bone graft reconstructions were done. CONCLUSIONS: Hemipelvectomy is an unusual procedure that is rarely performed because it is infrequently indicated and because of its high morbidity rate. In some reports, the morbidity rate has reached 77 percent of the cases. We did not perform any type of reconstruction or arthrodesis based on complications and the experience of good results with this method. Our results are similar to the main reports and are still subject of discussion by the oncologic surgeons. Level of evidence IV, Case-control study.

Hemipelvectomia: experiência do Hospital Erasto Gaertner com 32 casos em 10 anos / Hemipelvectomy: Erasto Gaertner Hospital's experiences with 32 cases in 10 years

OBJETIVO: Mostrar a experiência do Hospital Erasto Gaertner com as cirurgias de hemipelvectomias em um período de 10 anos. MÉTODOS: Estudo retrospectivo de 32 pacientes submetidos à hemipelvectomia de 1998 a 2008, avaliando características clínico-cirúrgicas. RESULTADOS: Dos 32 pacientes, 15 eram do sexo feminino e 17 do masculino. A média de idade foi de 37,94 anos. Oito casos apresentavam comprometimento de feixe vasculonervoso: três localizavam-se em ilíaco com extensão para a coxa, dois em acetábulo com extensão para coxa e três em acetábulo e púbis. Vinte e três apresentavam o feixe vasculonervoso livre de neoplasia: 11 restritos ao ilíaco, seis em região acetabular, dois em ramo púbico, quatro com extensão a toda hemipelve óssea. Um apresentava comprometimento de vasos ilíacos-femorais: um em ramo púbico. Sete casos de condrossarcoma e quatro de sarcoma de Ewing, representaram a maioria. Oito foram submetidos à hemipelvectomia externa e 24 à hemipelvectomia interna (11 tipo I, quatro tipo II, dois tipo II + III, três tipo III e quatro tipo IV). Destes 24 casos, 13 sem reconstrução, 10 com enxerto de fíbula e um com prótese de veia e artéria ilíaco-femorais. Vinte e seis cirurgias foram curativas e seis paliativas. Houve 14 óbitos. Sobrevida de dois e cinco anos observada em 11 e 10 casos, respectivamente. Seis casos apresentam menos de dois anos de cirurgia. Em três casos houve perda de acompanhamento. CONCLUSÃO: Os dados mostram a experiência de um serviço de referência em oncologia, especializado no tratamento de cirurgias de alta complexidade.

OBJETIVE: To review the experience of the Erasto Gaertner Hospital with hemipelvectomies of surgeries over a period of 10 years. METHODS: A retrospective study of 32 patients who underwent hemipelvectomy in Erasto Gaertner Hospital from 1998 to 2008, assessing clinical and surgical characteristics. RESULTS: Of 32 patients, 15 were female and 17 male. The mean age was 37.94 years. Eight cases showed involvement of the neurovascular bundle: 3 were located in the iliac and extended to the thigh, 2 were in the acetabulum and extended to the thigh and 3 were in the acetabulum and pubis. One involved the iliac-femoral vessels: one in the pubic ramus. Seven cases of chondrosarcoma and 4 cases of Ewing's sarcoma represented the majority. Eight underwent external hemipelvectomy and 24 underwent internal hemipelvectomy (11 were type I; 4 were type II; 2 were type II + III; 3 were type III and 4 were type IV). Of these 24 cases, 13 were without reconstruction, 10 were with a fibular graft and 1 was with an iliac-femoral vein and artery prosthesis. Twenty-six surgeries were curative and 6 palliative. There were 14 deaths. Survival of 2 and 5 years were seen in 11 and 10 cases, respectively. Six cases have less than 2 years of surgery. Three cases were lost during follow-up. CONCLUSION: The study shows the experiences of an exemplary oncology service, specializing in highly complex surgical treatment.

Evaluation of surgical treatment of pelvic osteosarcoma / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the clinical outcome of consecutive pelvic osteosarcoma treated with surgery and chemotherapy in a single institution, and to discuss the surgical strategy, resection and reconstruction.</p><p><b>METHODS</b>Twenty-one consecutive cases with pelvic osteosarcoma underwent surgical procedures between June 2000 and June 2009. There were 12 male and 9 female with a mean age of 32 years. According to Enneking and Dunham pelvic classification system, type Iwas 3 cases, type I+IV 3 cases, type I+II 4 cases, type II+III 4 cases, type I+II+III 1 case, type III 1 case, and type I+II+IV 5 cases. Among the 21 cases, 19 were diagnosed as classical osteosarcoma and 2 were diagnosed as low-grade pathologically. All the tumors were stage IIB. All the patients received en-bloc resection with 13 wide resection and 8 marginal resection. Thirteen patients underwent modular hemi-pelvic endoprosthesis reconstruction, and 5 patients underwent rod-screw system reconstruction combined with autograft. Two patients received hemipelvectomy and one type III patients had resection without reconstruction. The mean follow-up period was 30.3 months (range, 6.0-87.0).</p><p><b>RESULTS</b>Thirteen patients out of 21 survived after treatment. The overall survival rate was 61.9%, and 23.8% patients were alive without disease. The estimated 5-year survival rate was 44.2% based on Kaplan-Meier curve. The local recurrence rate was 28.6%, among which 4 cases were type II resection, 1 was type I resection, 1 was type I+IV resection.No local relapse was found on the hemipelvectomy and type III resection cases. The local recurrence rate after wide resection was 23.1%, and 37.5% for marginal resection.Nine patients had lung metastases and one patient was found bone and lymph node metastases. The MSTS 93 function score was 20.6 ± 5.4 for 13 patients, and 22.5 ± 2.1 for rod-screw reconstruction cases. The function score was 17.7 ± 5.5 for hemi-pelvic prosthetic reconstruction.</p><p><b>CONCLUSION</b>Limb salvage procedures could be performed on most pelvic osteosarcoma cases, and satisfying function outcome could be achieved with proper reconstruction, however, the overall survival is still lower compared with those in extremities.</p>

Increase of Independence in a Hemipelvectomy Patient with a Custom-Molded Supportive Seating and a Cosmetic Prosthesis : A case report

We report a case of hemipelvectomy, which was successfully treated with custom-molded supportive seating and a cosmetic prosthesis. A 32-year-old woman with a history of right traumatic hemipelvectomy, 24 years ago, visited our outpatient clinic for proper prosthetic rehabilitation. After injury, she was not able to use functional prostheses because of persistent skin problems of the hemipelvectomy site. She was able to perform all activities of daily living independently, but had to rely on crutch walking and was not able to sit on an even surface for longer periods of time. With the molded supportive seating the patient was able to perform outdoor activities for up to 10 hours. This case shows an approach in amputee rehabilitation, in which the ultimate goal of prosthetic fitting is not independent walking, but the improvement of independence and hence the improvement of quality of life.

Resultado funcional em crianças e adolescentes submetidos à hemipelvectomia interna tipo II, com ou sem reconstrução do anel pélvico / Functional outcome in children and adolescents submitted to type II internal hemipelvectomy with or without reconstruction of the pelvic ring

Objetivo: Avaliar retrospectivamente os resultados funcionais em crianças e adolescentes portadores de tumores pélvicos, submetidos à hemipelvectomia interna tipo II, com ou sem reconstrução do anel pélvico. Métodos: Foram avaliados 31 pacientes portadores de tumor pélvico, tratados no Centro Infantil Boldrini e no Hospital A.C. Camargo, entre 1994 e 2005. O resultado funcional foi baseado no sistema de avaliação funcional padronizado por Enneking et al. Os critérios analisados foram: dor, função, aceitação emocional, necessidade de suporte, capacidade de deambulação e marcha. Dos 31 casos seguidos, 12 (38,7%) fizeram a reconstrução do anel pélvico com enxerto de fíbula e 19 (61,3%) não a fizeram. A média de idade dos pacientes foi de 11,4 anos (4-17,8 anos). A média de seguimento para os 31 casos foi de 41 meses. Resultado: Obtido aos 12 meses do pós-operatório, foi excelente em 17,4% dos pacientes (todos com reconstrução do anel pélvico), bom em 60,9% dos pacientes, regular em 17,4% e ruim em 4,3%. A média do escore foi melhor no grupo de pacientes com a reconstrução com auto-enxerto de fíbula, comparativamente ao grupo dos que não tiveram essa reconstrução, sendo significativa a diferença entre os grupos (p = 0,008). Conclusão: Os pacientes submetidos à hemipelvectomia interna com reconstrução do anel pélvico com auto-enxerto de fíbula tiveram melhor resultado funcional global comparativamente ao grupo dos que não foram submetidos à reconstrução (p = 0,007). Dentre os critérios específicos do sistema de avaliação funcional, os escores obtidos nos itens aceitação emocional (p = 0,001), capacidade de deambulação (p = 0,034) e marcha (p = 0,002) foram melhores nos pacientes com reconstrução, quando comparados com os do grupo sem reconstrução do anel pélvico...

Internal hemipelvectomy, a limb saving procedure, NCI experience

Treatment of primary malignant tumors involving the pelvic girdle traditionally necessitated the sacrifice of a healthy lower extremity. Internal hemipelvectomy offers a safe alternative to this problem. With careful selection, the lower limb can be salvaged with acceptable function and hip stability. This study comprised 40 patients with malignant tumors of the pelvic bone treated by different types of internal hemipelvectomy at the National Cancer Institute [NCI], Cairo University in the period extending from 1996 to 2005. According to the location and extent of their tumors, they were ascribed to one of three groups. Group A included 28 patients who underwent type I hemipelvectomy [iliac bone resection], Group B included 8 patients who underwent type I+II hemipelvectomy [iliac and peri-acetabular resection] and group C included 4 patients who underwent type III hemipelvectomy [pubic bone resection]. The mean age for groups A, B and C was 35 +/- 11.9, 39 +/- 17.8 and 33.5 +/- 13 years; respectively. The study comprised 14 patients with Ewing's sarcoma, 12 patients with chondrosarcoma, 6 patients with osteosarcoma, 4 patients with giant cell tumor, 2 patients with aneurysmal bone cysts and 2 patients with malignant fibrous histocytoma. Neoadjuvant chemotherapy was given to 11 patients and 7 received preoperative chemotherapy and radiotherapy; whereas 22 patients received no neoadjuvant treatment. The mean +/- SD duration of the surgical procedure was 2.67 +/- 0.32 hours and the mean +/- SD intra-operative blood loss was 1323 +/- 233 ml. The difference between groups A, B, and C was statistically significant [p <0.05]. Intra-operative complications were encountered in 9 patients where 5 patients had various nerve injuries, 2 patients had vascular injury and 2 had bladder injury. In the postoperative period, 4 patients developed deep vein thrombosis, 7 showed wound infection, 3 had deep pelvic infection and 2 developed hematuria secondary to intra-operative bladder injury. Upon evaluation of the functional results obtained, 50% of the patients were judged to have good results and 30% had fair results and ambulation aids could be discarded after 6-8 months. The remaining 20%, who had undergone type I+II hemipelvectomy, demonstrated a poor functional result in the form of flail hip. At a median follow-up of 18 months, 70% of the patients were alive and free of disease, 17.5% were alive with loco-regional recurrence and 5 died; 3 from lung metastases and 2 of unrelated causes. Internal hemipelvectomy can achieve limb salvage in most cases of pelvic tumors without compromise to surgical margins, local control or survival rates. Functional results obtained with this technique were quite satisfactory when the hip joint could be preserved

Resection and reconstruction for tumors of iliac bone / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the resection of tumors, reconstruction of defects.</p><p><b>METHODS</b>Sixty-one patients with tumors in ileum were treated surgically in People's Hospital from July 1998 to July 2004. The series comprised 38 males and 23 females with an average age of 43 years old (range from 12 to 78 years old). According to Enneking staging system, 36 cases had lesions in region I, 17 cases in region I and II, and 8 cases in region I and IV. After tumor resected, posterior fixation system of spine was applied to reconstruct the integrality of pelvic ring in series of region I cases. The four pedicle screws were implanted in the lumbar and sacrum superiorly, pubis and ischium inferiorly. For children patients, bone graft or bone cement and Steinmann's pins internal fixation was applied to reconstruct the pelvis.</p><p><b>RESULTS</b>Among all the 61 cases, 48 cases followed up from 16 months to 6 years. Thirty-three cases were survived and had no local recurrence or metastasis. Fifteen cases were dead. Oncology result: local recurrence were found in 19.4% patients with region I resection (7/36), the resection level was close to acetabulum (in order to reserve the acetabulum), and it might be the reason of recurrence. 35.3% of patients (6/17) with region I and II resection had local recurrence, the recurrence maybe related to residual tumor after curettage. 50.0% of the patients (4/8) with region I and IV resection had local recurrence, the tumor residual in sacrum might be the reason of recurrence. Functional result: all of the 36 cases received region I resection regained normal walking function. The hip joint function was normal in 17 cases received tumor curettage, bone cement or hip joint replacement.</p><p><b>CONCLUSIONS</b>The posterior fixation system of spine can be used to reconstruct the integrality of pelvic ring after resection of iliac tumors. Simple reconstruction is more favorable for child patients. Allograft or self-ileum can be implanted in the space of sacral wing and residual ileum, and the bone graft is fixed with compressional screw.</p>

Recent Advances in Malignant Bone Tumor Treatment

The treatment of malignant tumors of the pelvic bone has been considered difficult. Many authors have reported lower rates of patients survival and high rates of complications after treatment of the malignant bone tumors of the pelvis. The size of the tumors often much greater than in other sites. Surgical resection and reconstruction often are more complex, based on the proximity of neurovascular structures. Resection of the tumor varies widely in size, type and location of the lesion. After resection of the tumor, reconstruction restoring anatomy of the pelvis and hip, maintaining the limb length and retaining function of the hip joint are challenging procedures. Reconstructions depend on extent and types of resection, type I(iliac). type II(periacetabular) and type III(pubic or ischial) and combined resection. Although limb salvage procedures are advisable in most of patients, there are times when external hemipelvectomy should be considered the treatment of choice. If surgical margin is not safe, or if major neurovascular structures are sacrificed for the wide resection, and consequently residual limbs are functionless, external hemipelvectomy should be considered. Once limb salvage surgery with resection is chosen as the most appropriate treatment for the patient, careful decision should be made whether reconstruction is necessary and what type of reconstruction is necessary. Most of type I resection could be reconstructed with sacroiliac arthrodesis with a recycled autograft or allograft. The vascularized bone graft may be augmented. Type II resections could be reconstructed with saddle prosthesis or recycled autograft with prosthesis composite. Type III resections are usually not necessary for reconstruction due to little functional impairment. However, most of type I, II combined resection and type I, II, III combined resection are almost impossible to solid reconstruction, and are not advisable to reconstruction. At times, it is appropriate to leave patients with a pseudarthrosis. Reconstruction should be individualized by types and extent of resection.

Hemipelvectomia com reconstrução por retalho miocutâneo anterior de coxa: relato de caso e descrição da técnica cirúrgica / Hemipelvectomy utilizing an anterior myocutaneous flap: case report and surgical technique description

A hemipelvectomia com reconstrução usando-se retalho miocutâneo ântero-medial da coxa, é indicada para o tratamento dos sarcomas da região glútea e da porção proximal posterior da coxa. O grande defeito cirúrgico é coberto pelo retalho miocutâneo do músculo quadríceps femoral. O resultado da hemipelvectomia com reconstruçãopor retalho miocutâneo anterior de coxa é excelente, exceto pela dor fantasma e sensação do membro persistenteem alguns pacientes. As considerações quanto à reabilitação e ao risco de dor e membro fantasma são similares aos associados aos outros tipos de hemipelvectomias. Em virtude da rápida cicatrização vista neste tipo de retalho, a adaptação de uma prótese, quando requerida, pode ser mais precoce. No presente trabalho apresentamos um caso em que foi realizado este tipo de cirurgia, procedendo-se à descrição da técnica cirúrgica utilizada.

Reabilitação na hemipelvectomia traumática / Rehabilitation for traumatic hemipelvectomy

A hemipelvectomia traumática constitui um evento raro, catastófico, cujos mecanismos de lesão e prognóstico são bem descritos na literatura. O crescente número de acidentes motociclísticos têm elevado a prevalência desta amputação, definindo o grupo de vítimas como jovens do sexo masculino sem comorbidade. Acarreta múltiplas sequelas físicas, psicológicas e sociais. Através da reabilitação, o paciente poderá recuperar independência funcional. A protetização é de grande valia, uma vez que os pacientes são jovens com prognóstico de marcha. Neste relato é apresentado o caso de uma vítima de hemipelvectomia traumática do sexo feminino, que se tornou independente para as atividades da vida diária após processo de reabilitação, que incluiu prótese, com melhora da qualidade de vida observada sob diversos aspectos. A protetização adequada não devolveu à paciente todas as finções perdidas, mas se constituiu em um instrumento capaz de melhorar-lhe a qualidade de vida.

Hemipelvectomías: experiencia en el hospital oncológico Padre Machado (1987-2001) / Hemipelvectomies: experience in the hospital ocologico Padre Machado (1987-2001)

Revisar nuestra experiencia. Analizar las hemipelvectomías realizadas en nuestro Servicio en un período de 15 años. De 48 hemipelvectomías, 12 fueron hemipelvectomías internas, 36 externas. La recurrencia local para hemipelvectomías internas fue del 0 por ciento para hemipelvectomías externas 38 por ciento y 20 por ciento para hemipelvectomías internas y externas respectivamente. Se registró un 58 por ciento de morbilidad para hemipelvectomías internas siendo la infección de la herida operatoria y la necrosis del colgajo las primeras causas. Las hemipelvectomías internas tuvieron 34 por ciento de morbilidad, siendo más frecuente la infección en herida operatoria. De 12 hemipelvectomías internas realizadas 11 fueron por tumores óseos, y una por tumor en tejidos blandos. El 50 por ciento de los pacientes con tumores óseos se clasificaron en estadio IB. 65 por ciento de los sarcomas de partes blandas fueron estadios III y IV. Los tumores óseos se localizaron más frecuentemente en fémur (55,50 por ciento), el comportamiento anterior del muslo fue localización más frecuente de los tumores de tejidos blandos (45 por ciento). Los tumores óseos fueron mayoritariamente osteosarcomas. La neoplasia de tejidos blandos más frecuente fue fibrohistiocitoma maligno. Las hemiplevectomías constituyen un procedimiento quirúrgico de considerable morbilidad, indicadas para una minoría de pacientes con tumor localmente avanzado. La hemipelvectomía interna está indicada en tumores del hueso pélvico o fémur proximal sin invasión vascular, mejorando la calidad de vida en pacientes jóvenes con sarcomas óseos

Hemipelvectomia interna alargada no tratamento de condrossarcoma pélvico localmente avançado: relato de caso / Extended internal hemipelvectomy for the treatment of locally advanced pelvic chondrosarcoma: a case report

É apresentado o caso de um paciente portador de condrossarcoma de baixo grau primário do osso ilíaco, com extensão para órgãos e estruturas adjacentes, tratado por hemipelvectomia interna alargada. São discutidos aspectos clínicos e abordagem terapêutica. O relato tem por finalidade ressaltar a importância da ressecção segundo princípios oncológicos, com preservação do membro, em pacientes que, face à extensão local, podem ser erradamente julgados como portadores de tumores irressecáveis.