• Marco Maricevich, Renata Maricevich, Harvey Chim, Steven L Moran, Peter S Rose, and Samir Mardini.
• Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
• J Plast Reconstr Aesthet Surg. 2014 Sep 1; 67 (9): 1257-66.

BackgroundReconstruction 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.MethodsA 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.ResultsFifty-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 cm(3) (range 196-13,980 cm(3)). 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.ConclusionsGluteal 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.Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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