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Background:. Sacral pathology requiring partial or total sacrectomy is rare, and reconstructing the ensuing defects requires careful decision-making to minimize morbidity. The purpose of this study was to review the experience of a single institution with reconstructing large sacral defects, to identify risk factors for suboptimal outcomes. Methods:. A retrospective chart review was conducted of all patients who underwent sacrectomy over a 10-year period. Univariate analysis of differences in risk factors between patients with and without various postoperative complications was performed. Multivariate logistic regression was used to identify predictive variables. Results:. Twenty-eight patients were identified. The most common diagnosis leading to sacrectomy was chordoma (39%). Total sacrectomy was performed on 4 patients, whereas 24 patients underwent partial resection. Reconstructive modalities included 15 gluteal advancement flaps, 4 pedicled rectus abdominis myocutaneous flaps, and 9 paraspinous muscle or other flap types. There was an overall complication rate of 57.1% (n = 12) and a 28.6% (n = 8) incidence of major complications. There were significantly more flap-related complications in patients who underwent total sacrectomy (P = 0.02). Large defect size resulted in significantly more unplanned returns to the operating room (P < 0.01). Conclusion:. Consistent with other published series', the overall complication rate exceeded 50%. Defect volume and sacrectomy type were the strongest predictors of postoperative complications and return to the operating room, while reconstructive strategy showed limited power to predict patient outcomes. We recommend that patients anticipated to have large sacral defects should be appropriately counseled regarding the incidence of wound complications, regardless of reconstructive approach.

Background: The burden of complex orthopaedic trauma in low-income countries is compounded by insufficient plastic surgeons to assist in management of soft tissue injuries. To address this global health-care disparity, we created a soft tissue management course to train orthopaedic surgeons from low-income countries in flap reconstruction. Methods: The Institute for Global Orthopedics & Traumatology hosts a 3-day course to teach orthopaedic surgeons from low-income and middle-income countries flaps using cadaver dissection and didactic lectures. Precourse and postcourse assessments were used to evaluate the course's effect. Findings: In 4 years, 156 surgeons have attended the course from more than 25 different countries. Of 48 participants from the 2010 course, 90% indicated that soft tissue management training would be useful for upper extremity trauma cases and 96% for lower extremity trauma cases. A 1-year postcourse use survey was sent to all the surgeons attending the 2012 course, with 32 of 44 surgeons completing the survey. The respondents collectively undertook 594 flaps with 554 reported as successful (93•3%). Of the successful flaps, 116 flaps were believed to have prevented a subsequent amputation. 31 (97%) of 32 surgeons disseminated information to either colleagues or residents, and through dissemination of information a further 28 surgeons are now undertaking flaps. Interpretation: The skills and knowledge gained at this course by orthopaedic surgeons from low-income countries were recorded to be quickly and extensively used in their countries by our 1-year postcourse survey. This course represents a unique collaboration with physicians in low-income countries that might have the ability to provide a sustainable effect in addressing global health care disparities. Funding: None.