Case 13 2026: Fillet Flap Reconstruction Following Hemicorporectomy for Recurrent High-Grade Gluteal Sarcoma

Keywords: Hemicorporectomy, Fillet flap, Spare-parts surgery, Sarcoma reconstruction, Complex pelvic reconstruction Authors: Authors: Isha Joshi MD MBA, Zachary Erlichman MD, Nia Nikkhahmanesh MD, Christina Chopra MD, Jason Ganz MD Institution: Stony Brook University Hospital, Stony Brook, New York Abstract Background: Tissue from non-salvageable limbs may be used in reconstruction of complex defects and represent the principle of the “spare- parts” concept.[1] Fillet flaps advantages include soft tissue coverage of large defects, biocompatibility of an autologous donor, and donor tissue resembling native tissue due to proximity. Case: Fewer than 100 hemicorporectomies have been published in the literature.[2] We present the case of a 53-year-old male who underwent hemicorporectomy for recurrent gluteal sarcoma followed by reconstruction using a near-total thigh fillet flap. Conclusions: Fillet flaps provide soft-tissue coverage of large defects, biocompatible autologous tissue, and donor tissue resembling native anatomy. Patient medical history Primary Diagnosis: In 2015, the patient was diagnosed with a 15-cm high-grade (grade 3) spindle cell carcinoma thought to represent a fibrosarcoma with transformation to dermatofibrosarcoma protuberans, located superior to the buttock. The tumor was resected at an outside hospital (OSH) without perioperative complications. First Recurrence: In 2016, the patient presented to the OSH with recurrent mass in the tumor bed measuring 12.2 cm with erosion of lower coccyx, extension into posterior pelvis, and deviation of the anus. He underwent neoadjuvant radiation and systemic therapy. In 2017, he underwent tumor debulking and permanent diverting colostomy placement. After relocating to New York, he established care at our institution and subsequently underwent conversion of a loop colostomy to an end stoma with mucous fistula in 2020. Secondary Recurrence: In 2022, imaging demonstrated a recurrent tumor above the buttock. The pat