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Characterization of soft tissue reconstruction following chordoma resection: a series of 68 consecutive cases
Shanmuga Priya Rajagopalan
*, Danielle Sim, Waldemar Rodriguez-Silva, Ananya Dewan, Siam Rezwan, Carisa Cooney, Salih Colakoglu
Plastic surgery, Johns Hopkins University, Baltimore, MD
Background:Chordomas, which are rare malignant tumors of the axial skeleton, often require soft tissue reconstruction post-extirpation due to large resection margins. Little data exist to inform reconstructive approaches based on anatomical considerations. This study aims to describe factors associated with reconstruction following lower lumbar or sacral chordoma resection.
Methods:We retrospectively reviewed charts of patients who underwent reconstruction post-excision of chordomas derived from lower lumbar (L4-L5) or sacral regions at a single institution between 2013-2023. We used Wilcoxon rank sum, Chi-squared, Fisher's exact, and Kruskal-Wallis tests to compare outcomes based on reconstruction method.
Results:Sixty-eight patients met inclusion criteria; 53% (n=36) received gluteus maximus (GM) flaps. Vertical rectus abdominis muscle (VRAM) and paraspinous muscle (PSM) flaps were the next most-commonly used [n=12 (18%) each]; 8 (12%) patients underwent reconstruction without incorporation of muscle (e.g., fasciocutaneous flaps). GM and VRAM flaps were primarily used to reconstruct defects at the level of the sacrum (n=47, 98%) while 7 (58%) and 5 (42%) PSM flaps were used for lumbar and sacral reconstruction, respectively. Median (interquartile range [IQR]) tumor volume in patients who underwent VRAM flap reconstruction was significantly greater than GM flaps [468cm
3 (271-1592) vs. 92cm
3 (12-246), p=0.002). Median (IQR) defect diameter managed by VRAM flaps was significantly longer compared with GM flaps [33cm (30-46) vs. 22cm (15-30), p=0.001]. Median (IQR) follow-up was 34 (13-73) months and 27 (68%) patients developed surgical complications: dehiscence (n=16, 24%), infection (n=9, 13%), seroma (n=5, 7%), and partial flap necrosis (n=2, 3%). Reconstruction type was not associated with incidence of post-operative complications. Chordoma recurred in 12 (17%) patients.
Conclusion:Surgical reconstruction post-chordoma resection varied depending on spinal level, tumor volume, and defect diameter. Complication rates were similar among reconstructive options.
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