Midurethral autologous fascial sling surgery with reconstruction of the lower abdominal wall using the tensor fascia lata muscle flap for post‐hemipelvectomy stress urinary incontinence

Hemipelvectomy is surgery for pelvic bone neoplasms. In the case of pubic bone osteosarcoma, the distal end of the rectus abdominis muscle is severed from the pubic and ischium bones, and the pelvic floor muscles are resected en bloc with the bone, which leads to stress urinary incontinence. Cancer control is prioritized over complications, and stress urinary incontinence is generally disregarded. A 25‐year‐old woman presented with stress urinary incontinence. She had undergone a hemipelvectomy for left pubic bone osteosarcoma, and stress urinary incontinence appeared and persisted since the surgery. We carried out a reconstruction of the tissue deficit of the rectus abdominis using the tensor fascia lata muscle flap simultaneously with a midurethral autologous fascial sling anchoring to the tensor fascia lata flap. Stress incontinence was successfully improved without morbidity. This is the first reported case of midurethral suspension with reconstruction of the lower abdominal wall with the tensor fascia lata flap for post‐hemipelvectomy stress urinary incontinence.     

Anterior thigh flap extended hemipelvectomy and spinoiliac arthrodesis

We present the technique of anterior thigh flap extended external hemipelvectomy with spinoiliac arthrodesis in treatment of the patient with recurrent low-grade pelvic chondrosarcoma extending to the lower lumbar spine. Extended hemipelvectomy involves skeletal resection beyond the standard hemipelvectomy that is the SI joint by removal of contiguous musculoskeletal structures, such as elements of the sacral and lumbar spine or contralateral pelvic bone, in addition to the affected innominate bone. Spinoiliac arthrodesis reestablishes spinopelvic stability; the anterior thigh musculocutaneous flap provides reliable well-vascularized soft tissue coverage. This technique may serve an important role in the surgical management of patients with low-grade pelvic malignancies.     

Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma

Aim Eight highly selected patients are reported, undergoing external hemipelvectomy (EHP) for malignant infiltration of the lumbosacral neural plexus. Method All patients were evaluated by positron emission tomography‐computed tomography (PET‐CT), CT and magnetic resonance imaging. No evidence of disseminated disease was found. With agreement by the multidisciplinary team, surgery was performed by a colorectal surgeon and an orthopaedic sarcoma surgeon and, if needed, by an urologist and vascular surgeon. Patients were reconstructed with either a femoral or a gluteal musculocutaneous flap. Results Of the eight women [median age 54.5 (40–68) years], two had primary carcinoma and six local recurrence of a previously treated carcinoma. R0 was possible in six patients and R1 resection in two. The median duration of hospital stay was 29.5 (17–102) days. The median follow up was 8.3 (4.7–52.8) months. Three patients have died, one from postoperative complications at 5 months and two from recurrence at 5 and 52.8 months. Phantom‐limb was experienced in six patients. Four patients received a prosthesis, one is considering this and one does not want a prosthesis. Conclusion Hemipelvectomy may be considered for a highly selected group of patients with locally advanced carcinoma or recurrence involving the lumbosacral neural plexus.     

Successful pregnancy after limb-sparing hemipelvectomy for Ewing sarcoma: Case report and literature review

ObjectiveWe present a case of successful pregnancy in a patient who underwent limb-sparing hemipelvectomy combined with multi-agent chemotherapy and radiotherapy for Ewing sarcoma.Case reportA 17-year-old girl was diagnosed with Ewing sarcoma of the left pelvis at the age of 17 and received limb-sparing hemipelvectomy combined with multi-agent chemotherapy and radiotherapy. The patient received oral contraceptives as hormone replacement therapy after completion of treatment. A normal menstruation cycle restored after the withdrawal of oral contraceptives. The patient spontaneously conceived at the age of 25. The patient complained of difficulty walking due to pelvic distortion during pregnancy and delivered a healthy neonate at term by cesarean section.ConclusionSuccessful pregnancy and delivery can be achieved after limb-sparing hemipelvectomy combined with chemotherapy and radiotherapy for Ewing sarcoma. Our report provides important information on perinatal management, given the low incidence of pregnancy following treatment of Ewing sarcoma in the pelvis.     

Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors

This is a retrospective analysis of 16 patients with primary malignant pelvic tumors who underwent wide resection of the hemipelvis and consequent reconstruction between 2003 and 2007. Mean patient age was 27 years, whereas median follow-up was 36 months (range, 23-62 months). Hemipelvic prostheses were individually designed for each patient based on preoperative computed tomographic scans and consequent surgical modeling. The 3-year prosthesis survival rate was 69%. There were 3 cases of local recurrence (19%), and 4 patients died because of pulmonary metastases. The mean follow-up Musculoskeletal Tumor Society functional score was 72%. In conclusion, computer-aided custom-made hemipelvic prosthesis can be applied to quickly and effectively restore the bone defect after internal hemipelvectomy for treatment of pelvic tumors.     

胎儿肾血管彩色多普勒检测

本文报道了应用彩色多普勒超声显像仪对４６例胎儿肾动脉血流的测定结果。胎儿肾动脉血流在发育不同阶段呈规律的变化：Ｖｓ、Ｖｄ、Ｔａｍｘ、ＣＴＩ随胎龄的增加呈递增趋势，Ｖｓ／Ｖｄ随胎龄增加呈递减趋势，Ｖｓ反映肾动脉血流量，Ｖｄ反映肾动脉血管阻力，ＰＩ、ＲＩ在各胎龄期无明显差异。结果表明：应用多普勒超声检测胎儿肾动脉血流来评价胎儿周围循环状态，预测胎儿的发育情况是可行的，并且是可靠的。     

骨盆环区域骨肿瘤的外科治疗

目的：评价半骨盆截除术、内半骨盆切除体外灭活再植 或单纯旷景术、插入式微波天线阵列诱导高温原位灭活术治疗骨盆部肌肿瘤;部分切除术及前后联合入路局部乔除并辅助以局部单纯放疗或（和）置管持续灌注化疗术治疗骶骨肿瘤的效果。探讨骨盆环区域骨肿瘤的各种外科治疗方法的优缺点,以便更有效的治疗该部位肿瘤。方法：７ａ中外科治疗骨盆环区域各类良、恶性肌肿瘤１４６例,其中应用半骨盆截除术治疗晚期骨盆骨肿瘤４４例。方法