Extracorporeal Perfusion for Free Fillet Lower Leg Flap After External Hemipelvectomy for Recurrent Osteosarcoma: A New Surgical Technique

BackgroundExternal hemipelvectomy often results in exposure of noble structures such as pelvic organs, joint surfaces, iliac neurovascular bundle and bone. Consequently, reconstructive surgery is always challenging. The free fillet lower leg flap is an optimal solution since it allows the transfer of a large amount of tissue and the it determines the absence of donor site morbidities. The prolonged ischemic time represents the weak point of this flap.Methods We presented the case of a 38-year-old man with recurrent radio-induced osteosarcoma arisen on pelvic cavity and involving common iliac vessels, bladder, left ureter and left kidney. We decided to use extracorporeal circulation (ECMO) in order to reduce ischemic time of the flap, since iliac vessels were necessary ligated in the middle of oncologic resection. We perfused the popliteal-based filleted lower leg musculocutaneous free flap with homologue blood and saline solution, while the oncologic dissection was completed.ResultsThe free fillet flap remained vital in the immediate postoperative period and in the following months. The patient did not come back to a life-threatening condition at 1y follow-up. ConclusionWe believed that ECMO expand the reconstructive indications in those cases in which a complex and long-lasting oncologic resection would make impossible a free flap due to prolonged ischemic time.