Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort
Abstract Background The T-incision approach for internal hemipelvectomy necessitates extensive dissection to expose the posterior pelvic structures, leading to higher rates of wound complications. A modified separated-incision approach was developed and validated in this comparative study. Patients...
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BMC
2025-07-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-08944-x |
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| author | Jianping Hu Kunpeng Zhu Tao Cai Xiaolong Ma Yongjie Wang Enjie Xu Chunlin Zhang |
| author_facet | Jianping Hu Kunpeng Zhu Tao Cai Xiaolong Ma Yongjie Wang Enjie Xu Chunlin Zhang |
| author_sort | Jianping Hu |
| collection | DOAJ |
| description | Abstract Background The T-incision approach for internal hemipelvectomy necessitates extensive dissection to expose the posterior pelvic structures, leading to higher rates of wound complications. A modified separated-incision approach was developed and validated in this comparative study. Patients and methods The separated-incision approach used two distinct incisions: an anterior incision that combines the ilioinguinal approach with a short, straight Smith-Petersen incision; and a separated posterior incision for the posterior pelvic structures. This approach was applied to 8 patients with internal hemipelvectomy related to type II + III regions. Seventeen patients underwent a traditional T-incision approach during the same period were matched for comparison. Results The separated-incision approach was successfully performed in these eight patients, preserving the gluteal vessels and posterior skin-muscle flap. Lower blood loss (2375 vs. 3952 mL, p = 0.005), and similar operative time (312 vs. 398 min, p = 0.098) was observed. Postoperative haemoglobin was higher (88.1 vs. 74.8 g/L, p = 0.009), and drainage volumes were marginally reduced (1379 vs. 1917 mL, p = 0.209). Compared to 8 patients in the T-incision group who experienced wound complications including delayed wound healing (n = 4) and surgical site infection (n = 4), all patients in separated-incision group achieved primary wound healing within 3 weeks (47% vs. 0%, p = 0.026). Additionally, they had a shorter time to ambulation (39 vs. 62 days, p = 0.015) and higher MSTS scores (24.25 vs. 20.47, p = 0.006). No differences were observed in local recurrence or overall survival. Conclusions The separated-incision demonstrated fewer wound complications and faster mobilization, suggesting it is a promising alternative; multicentre validation is warranted. Level of evidence Level III, Retrospective cohort study. |
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| institution | DOAJ |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-e0ac30672f09440684d7eb2cdc4b3e4b2025-08-20T03:04:21ZengBMCBMC Musculoskeletal Disorders1471-24742025-07-0126111110.1186/s12891-025-08944-xSeparated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohortJianping Hu0Kunpeng Zhu1Tao Cai2Xiaolong Ma3Yongjie Wang4Enjie Xu5Chunlin Zhang6Department of Orthopedic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Orthopedic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Orthopedic Surgery, Tongji Hospital Affiliated to Tongji University, Tongji University School of MedicineDepartment of Orthopedic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineProteomics and Cancer Cell Signaling Group, German Cancer Research Center (DKFZ)Department of Orthopedic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Orthopedic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineAbstract Background The T-incision approach for internal hemipelvectomy necessitates extensive dissection to expose the posterior pelvic structures, leading to higher rates of wound complications. A modified separated-incision approach was developed and validated in this comparative study. Patients and methods The separated-incision approach used two distinct incisions: an anterior incision that combines the ilioinguinal approach with a short, straight Smith-Petersen incision; and a separated posterior incision for the posterior pelvic structures. This approach was applied to 8 patients with internal hemipelvectomy related to type II + III regions. Seventeen patients underwent a traditional T-incision approach during the same period were matched for comparison. Results The separated-incision approach was successfully performed in these eight patients, preserving the gluteal vessels and posterior skin-muscle flap. Lower blood loss (2375 vs. 3952 mL, p = 0.005), and similar operative time (312 vs. 398 min, p = 0.098) was observed. Postoperative haemoglobin was higher (88.1 vs. 74.8 g/L, p = 0.009), and drainage volumes were marginally reduced (1379 vs. 1917 mL, p = 0.209). Compared to 8 patients in the T-incision group who experienced wound complications including delayed wound healing (n = 4) and surgical site infection (n = 4), all patients in separated-incision group achieved primary wound healing within 3 weeks (47% vs. 0%, p = 0.026). Additionally, they had a shorter time to ambulation (39 vs. 62 days, p = 0.015) and higher MSTS scores (24.25 vs. 20.47, p = 0.006). No differences were observed in local recurrence or overall survival. Conclusions The separated-incision demonstrated fewer wound complications and faster mobilization, suggesting it is a promising alternative; multicentre validation is warranted. Level of evidence Level III, Retrospective cohort study.https://doi.org/10.1186/s12891-025-08944-xInternal hemipelvectomyT-incision approachWound complicationsSeparated-incisionPelvic tumours |
| spellingShingle | Jianping Hu Kunpeng Zhu Tao Cai Xiaolong Ma Yongjie Wang Enjie Xu Chunlin Zhang Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort BMC Musculoskeletal Disorders Internal hemipelvectomy T-incision approach Wound complications Separated-incision Pelvic tumours |
| title | Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort |
| title_full | Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort |
| title_fullStr | Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort |
| title_full_unstemmed | Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort |
| title_short | Separated-incision versus T-incision for internal hemipelvectomy related to Enneking type II + III resection: comparative outcomes in a single-center retrospective cohort |
| title_sort | separated incision versus t incision for internal hemipelvectomy related to enneking type ii iii resection comparative outcomes in a single center retrospective cohort |
| topic | Internal hemipelvectomy T-incision approach Wound complications Separated-incision Pelvic tumours |
| url | https://doi.org/10.1186/s12891-025-08944-x |
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