Abstract
Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon.
 Fasciocutaneous flaps are tissue flaps that include skin, subcutaneous tissue and the underlying fascia. Including the deep fascia with its prefascial and subfascial plexus enhances the circulation of these flaps. They can be raised without skin and are then referred to as fascial flaps. The present study was planned to evaluate the perforater Sparing Gluteal Fasciocutaneous flap for Sacral pressure sore.
 The rotation Gluteal Fasciocutaneous flap for sacral pressure sore coverage have distinct advantage of rotation in the event of ulcer recurrence. The flap from the gluteal crease derives blood supply from the inferior gluteal artery perforator (IGAP) and reliably preserves the entire contralateral side as a donor site.
 The author describe their approach of preserving and incorporating musculocutaneous perforators into the conventional rotation design.Data from 11 patients (8 men, 3 women; mean age [range 24-71] years old) whose sacral ulcers were closed with an IGAP flap between from Jan 2017 to Apr 2018 June were retrieved and reviewed. All patients were bedridden; 1 patient in a vegetative state with a diagnosis of Cerebro vascular accident was referred from a local clinic, 2 patients had pelvic bone fracture on long duration traction, and 2 patients had a history of Cervical injury leading to quadriplegia , and 6 patient have hemiplegia due to spinal injury . The average defect size was 110 cm(2) (range 78-134 cm(2)). The average flap size was 75.8 cm(2) (range 46-111 cm(2)).
 After surgery, the patients' position was changed every 2 hours; patients remained prone or on their side for approximately 2 weeks until the flap was healed. After healing was confirmed, patients were discharged. Complications were relatively minor and included 1 donor site wound dehiscence that required wound reapproximation. No surgery-related mortality was noted; the longest follow-up period was 24 months.
 The present study was planned in the Department of Plastic Surgery, Pulse Emergency Hospital, Patna, Bihar. Total 11 cases of the operated from Jan 2017 to Apr 2018 were included in the present study. All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Approval of the institutional ethical committee was taken prior to conduct of this study.
 The data generated from the present study concludes that the modified method we proposed is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little donor-site morbidity. Once sufficient padding is established in cases like this, a takeaway from this report would be to study the recurrence rates compared with the classic fasciocutaneous flap.
 Keywords: Fasciocutaneous flaps, Sacral pressure, sore, etc.
Highlights
Managing sacral pressure ulcers is a common problem for reconstructive surgeons
Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon
The data generated from the present study concludes that the modified method we proposed is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little donor-site morbidity
Summary
Managing sacral pressure ulcers is a common problem for reconstructive surgeons. Local flaps created from the gluteal region are preferred when wound closure is needed due to their reliability and short learning curve for surgeons. The perforator-preserving gluteal artery-based rotation fasciocutaneous flap is a reliable, reusable flap that provides rich vascularity facilitating wound healing and accommodating the difficulties of pressure sore reconstruction.The rotation Gluteal. Fasciocutaneous flap for sacral pressure sore coverage have distinct advantage of rotation in the event of ulcer recurrence.Three types of flaps involving the gluteal crease based on different terminal branches of the inferior gluteal artery have been described in the literature: the infragluteal flap,[4] the inferior gluteal artery perforator (IGAP) flap,[5,6] and the inferior gluteal artery myocutaneous flap.[7] Many clinicians harvest free flaps from the gluteal crease region for breast reconstruction because of its fatty composition.[4,5,6] Gluteal crease flaps provide positive aesthetic results for both the breast reconstruction and donor site scar without sacrificing muscle at a donor site.
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