Modified Hemipelvectomy Utilizing an Anteromedial Vascularized Myocutaneous Flap
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When the decision for hemipelvectomy has been made, careful attention must be paid to the condition of the soft tissue surrounding the hip, the buttocks, and the anterior thigh, as well as the vascularity to the area. The standard hemipelvectomy technique described by Banks and Coleman utilizes a large posterior flap which is brought anteromedially for closure. This vascularized myocutaneous flap consists primarily of the gluteus maximus and the skin and subcutaneous tissue that overlie the buttock and the proximal lateral portion of the thigh to just below the greater trochanter. It is vascularized by the superior and inferior gluteal arteries, which are the two distal branches of the posterior division of the internal iliac system. A variety of conditions may preexist which jeopardize the viability of this posterior flap, with wound dehiscence and skin necrosis having been reported to occur in 26 to 80% of hemipelvectomies done in this classic manner.
KeywordsProximal Femur Superficial Femoral Artery Myocutaneous Flap Sciatic Notch Inferior Gluteal Artery
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