Variants of hemipelvectomy and their complications.

In the period from 1976 through 1986, 62 procedures were performed. Of these, 42 were posterior flap hemipelvectomies, 5 anterior flap hemipelvectomies, and 15 internal hemipelvectomies. The median duration of these procedures was 6.5 hours, and the median blood loss was 2,541 ml. Postoperatively, there were no wound problems in 38 procedures (61 percent). The overall rate of flap necrosis was 15 percent, and the overall rate of wound infection, 17 percent. The viability of the posterior flap was not dependent on the level of division of the iliac vessels. By leaving the gluteus maximus muscle attached to the posterior flap, the rate of flap necrosis, initially 55 percent, was eliminated completely in the last 38 patients. Including 11 recently performed procedures, the operative mortality rate was 1 percent (1 of 73 procedures). For patients operated on with curative intent, the estimated 5-year survival rate was 43 percent.