Soft Tissue Reconstruction Following Surgery for Sacral Chordoma

Oncological resection of chordomas of the mobile spine and sacrum frequently involves the creation of large soft tissue defects and significant destabilization of the bony elements. Achieving good long-term results is therefore contingent upon successful stabilization and soft tissue reconstruction. This is notably difficult at the lumbosacral junction, where partial sacrectomy resecting >50% of the sacroiliac joints, or total sacrectomy, results in loss of spinopelvic continuity and generates an enormous soft tissue defect. Restoration of spinopelvic continuity is essential for postoperative return of function, as it determines loadbearing during walking, standing, and sitting. Sacral defects can be reconstructed with vascularized bone flaps, regional flaps such as the pedicled vertical rectus abdominis myocutaneous flap, local flaps such as gluteus-based or paraspinous flaps, local tissue rearrangement, free tissue transfer, or a combination of these techniques. In this chapter, methods for soft tissue reconstruction following sacrectomy are discussed, along with the pros and cons of previously published technique.