Flap reconstruction for sacrectomy defects: A systematic review and meta-analysis

Background: Following the excision of sacral tumors, plastic surgeons are often faced with a large soft tissue defect that necessitates flap coverage to promote wound healing and obliterate the resulting dead space. We aimed to evaluate the outcomes and complications following soft tissue reconstruction of sacrectomy defects. Methods: Applying the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), a comprehensive search of several databases was performed from 1950 to 2019 for articles reporting outcomes of soft tissue flap reconstruction after sacrectomy. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. Results: A total of 544 articles were identified in the initial search, out of which 26 met our inclusion criteria. Gluteal-based flap was the most commonly used (50%), followed by the vertical rectus abdominis myocutaneous (VRAM) flap (38%) and free latissimus dorsi (5%). Patients who underwent high sacrectomy had significantly higher local complications than those who underwent low sacrectomy [OR: 2.57(1.12,5.92); p = 0.03]. Patients who received preoperative radiation had a significantly higher complication rate than those who did not [OR: 2.91(1.25,6.79); p = 0.01]. The pooled local complication rate was 37% in the gluteal-based flap group and 50% in the VRAM flap group. Total flap loss was identified in 1 gluteal and 2 VRAM flaps. Conclusion: Gluteal-based and VRAM flaps are the two most common options for soft tissue reconstruction after sacrectomy. Both flaps demonstrate a high complication rate after this morbid procedure; however, total flap loss seems to be a rare occurrence. Most patients can achieve good functional outcome following reconstruction.