Abstract
The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients' age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%). Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p = 0.087). Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity.
Highlights
Pressure sores are challenging to medical and nursing staff because they are slow to heal, prone to recurrence, and difficult to reconstruct [1,2,3]
A musculocutaneous flap has the advantage of sufficient padding at the pressure point, but, on the other hand, it has limitation on arc of rotation, and, over time, the padded muscle portion may experience atrophic degeneration
Between March 2011 and December 2013, a total of 13 patients were admitted to our institution with a sacral sore and were treated with a modified gluteal fasciocutaneous flap
Summary
Pressure sores are challenging to medical and nursing staff because they are slow to heal, prone to recurrence, and difficult to reconstruct [1,2,3]. The sacral region is one of the most common locations for such wounds, and surgical methods are required when conservative measures fail [4]. Gluteal flaps have been used for treating sacral sores since 1970 [5]. A musculocutaneous flap has the advantage of sufficient padding at the pressure point, but, on the other hand, it has limitation on arc of rotation, and, over time, the padded muscle portion may experience atrophic degeneration. The central portion of the gluteus muscle is relatively thinner than the lateral side normally, so padding of the sacral region with a standard musculocutaneous flap is not easy (Figure 1)
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