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Hernia (2009) 13:329332DOI 10.1007/s10029-008-0449-y
CASE REPORT
Single-stage sacral coccygectomy and repair using human acellular dermal matrix (AlloDerm) with bilateral gluteus maximus Xaps for hernia prophylaxis
J. M. Korn M. M. Connolly R. L. Walton
Received: 8 September 2008 / Accepted: 13 October 2008 / Published online: 8 November 2008 Springer-Verlag 2008
Abstract Sacrococcygectomy is often necessary for the ablation of malignancies involving the sacrum and coccyx, and can result in deep posterior peritoneal defects with disruption of the pelvic Xoor. Such a radical procedure is frequently associated with signiWcant morbidity, including sacral herniation. Numerous techniques for the closure of the surgical defect have been described, with varying degrees of success in avoiding future herniation. We report the Wrst single-stage coccygectomy and partial sacrectomy with closure utilizing human acellular dermal matrix (HADM) (AlloDerm; LifeCell Corporation, Branchburg, NJ) and bilateral gluteus maximus transposition Xaps.
Keywords Chordoma Sacral hernia
Sacrococcygectomy Human acellular dermal matrix
Introduction
Total or partial sacrectomy with concurrent coccygectomy can result in deep posterior peritoneal defects and disruption of the pelvic Xoor [1]. Consequently, radical resections of this nature are associated with high morbidity. Among the more commonly encountered complications are neurologic injury, infection, wound breakdown, and sacral herniation [24]. Despite these known potential morbidities, en-bloc resection of the sacrococcyx is necessary for the treatment of malignant chordomas, giant cell carcinomas, sarcomas, and rectal adenocarcinomas arising in the sacral and presacral area. Numerous techniques for the
closure of the resultant posterior defect have been described in the literature. Recently, Brizendine et al. [3] reported the use of acellular human dermis graft (AlloDerm) for the closure of a parasacral hernia. In that case, the reconstructive eVort was performed one year after the initial resection [3]. We describe the Wrst single-stage, multidisciplinary approach of coccygectomy and partial sacrectomy for the treatment of a sacral chordoma utilizing human acellular dermal matrix (HADM) (AlloDerm; LifeCell Corporation, Branchburg, NJ) and bilateral gluteus maximus transposition Xaps for closure.
Case report
A 63-year-old male presented with an 11-month history of progressive bilateral lower extremity weakness, left greater than right, and diYculty ambulating. In addition, the patient complained of lower back pain, urinary hesitancy, constipation, and sexual dysfunction. His past medical history was signiWcant only for benign prostatic hypertrophy. Upon initial physical examination,...