Reconstruction following partial and total sacrectomy defects: An analysis of outcomes and complications

Background Reconstruction of sacrectomy defects following ablative surgery remains a challenge, with high complication rates in the reported literature. The size of the defect is the primary consideration for flap choice; however, the cause of intra-abdominal and flap complications remains unclear. The aim of the study was to evaluate our results for sacrectomy flap reconstruction in order to determine predictive or protecting factors for complications. Methods A 13-year retrospective review was performed of all patients who had reconstruction for partial and total sacrectomy defects at the Mayo Clinic in Rochester, MN, USA. Demographics, flap choice, and complications were analyzed. Multivariate analysis was used to determine factors causing flap and intra-abdominal complications. Results Fifty-four patients underwent reconstruction. Partial sacrectomy was performed in 38 (70.4%) patients, while total sacrectomy was performed in 16 (29.6%) patients. The average wound defect volume was 2136 cm³ (range 196-13,980 cm³). Flaps used included gluteal (n = 15; 27.8%), rectus abdominis myocutaneous (RAM) (n = 37; 68.5%), and combined gluteal/RAM (n = 2; 3.7%). Obesity was significantly associated with intra-abdominal complications (p < 0.05) while preoperative radiotherapy and chemotherapy were not. Flap and wound healing complications were not significantly associated with any factors. Conclusions Gluteal advancement and vertical RAM or transverse RAM flaps are both reliable options for reconstruction of sacrectomy defects. The use of acellular dermal matrix (ADM) for reconstructing the posterior abdominal wall provides a barrier between the intra-abdominal contents and flap, preventing bowel adhesions/obstruction and fistulas as well as prevents sacroperineal hernia.