Bilateral Gluteus Maximus Myocutaneous Flap

Abstract

The gluteus maximus myocutaneous flap has been popularized as a workhorse flap for reconstruction of large sacral and in certain cases of perineal defects. The flap is perfused by the inferior and superior gluteal arteries. The flap can be used as rotational or advancement flaps. It is thought that the use of advancement flap is less likely to affect the function of the muscle and thus more appropriate for ambulatory patients. Based on the size of the defect and the need for advancement, either unilateral or bilateral flaps may be used. In this section, we will focus on bilateral advancement flaps. In this design, the advancement is done in a V-Y fashion and the medial portion of the flaps are elevated and advanced to cover the sacral defect. This technique preserves the area contour and better preserves location and shape of gluteal cleft compared to other designs. Hip stability and function of the gluteus maximus is maintained, as the neurovascular supply is kept intact. Donor sites are closed primarily without tension in a V-Y fashion. With appropriate post-operative care including pressure off-loading in air-fluidized bed, culture-directed antibiotics, and aggressive rehabilitation and nutrition optimization, long-term outcomes are favorable.