Background: Pelvic resections are complex and challenging in oncologic practice and infection is the most common complication. Our study aims to evaluate whether flap coverage procedures influence infection rates compared to primary closure after major pelvic resection for sarcomas.

Methods: A retrospective comparative study was conducted among pelvic sarcoma patients who underwent surgery between Jan1 2019 and Jan 1 2025 at Nepal Cancer Hospital and Research center. Patients were divided into two groups: Flap group and No flap group. Outcomes measured included wound dehiscence, superficial SSIs, and deep infections requiring surgical intervention.

Results: Total 36 patients were included in the study. 20 were in Flap group and 16 were in No Flap group. While there was no significant difference between the groups regarding minor complications like wound dehiscence or superficial infection (p = 0.4217. Deep infection occurred in 31% (5/16) of the No Flap group, whereas no deep infections (0/20) were recorded in the Flap group (p = 0.0135). One patient in the Flap group experienced flap necrosis requiring revision flap coverage.

Conclusion: Vascularized muscle transfers significantly reduce deep pelvic infections following major pelvic sarcoma resections.

Keywords: Infection; Internal Hemipelvectomy; Muscle Flaps; Pelvic Sarcoma