Free fillet lower leg flap with fenestration of the pelvis as prevention of vascular problem after hemipelvectomy

We read with great interest the article by L. Kreutz-Rodrigues et al. from Mayo Clinic: Reconstruction of complex hemipelvectomy defects: a 17-year single-institutional experience with lower extremity free and pedicled flaps 1 Kreutz-Rodrigues L. Weissler J.M. Moran S.L. et al. Reconstruction of complex hemipelvectomy defects: A 17-year single institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthetic Surg. 2020; 73: 242-254https://doi.org/10.1016/j.bjps.2019.09.028 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar . Congratulations to the authors for the excellent results and for including the largest published group of patients to date. We completely agree with the harvesting technique as described by the authors. We believe that the elevation of the flap with fibula is faster 2 Bibbo C. Newman A.S. Lackman R.D. Levin L.S. Kovach S.J A simplified approach to reconstruction of hemipelvectomy defects with lower extremity free fillet flaps to minimize ischemia time. J Plast Reconstr Aesthetic Surg. 2015; 68: 1750-1754https://doi.org/10.1016/j.bjps.2015.07.006 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ,3 Faria J.C. Aguiar S. Ferreira F de O. Lopes A Fillet flap for reconstruction after hemipelvectomy: report of three cases. J Plast Reconstr Aesthetic Surg. 2009; 62: e110-e111https://doi.org/10.1016/j.bjps.2008.06.075 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar and in addition the fibula can be used to reconstruct the pelvic ring. Certainly, double-team surgery is standard for time-saving and minimising the ischaemia time. However, we consider the use of a pedicled flap with rotation of the pedicle in the pelvis or bending of the vascular pedicle around the edge of iliac crest too risky. It can cause venous thrombosis, as described by Kreutz-Rodrigues et al. 1 Kreutz-Rodrigues L. Weissler J.M. Moran S.L. et al. Reconstruction of complex hemipelvectomy defects: A 17-year single institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthetic Surg. 2020; 73: 242-254https://doi.org/10.1016/j.bjps.2019.09.028 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar . Previous studies have reported the occurrence of venous thrombosis in three out of seven cases 4 Roulet S. Le Nail L.R. Vaz G. et al. Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation. Orthop Traumatol Surg Res. 2019; 105: 47-54https://doi.org/10.1016/j.otsr.2018.10.018 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar . We propose a technique where the vascular pedicle can be inserted into the pelvis through a bone window, allowing for successful vascular anastomosis without any vascular complications. Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flapsJournal of Plastic, Reconstructive & Aesthetic SurgeryVol. 73Issue 2PreviewHemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. Full-Text PDF