Flap from the Gluteal Crease for Sacral Sore Reconstruction

Abstract

Background: Sacral sore reconstruction is a common task for a plastic surgeon, but the condition becomes complicated if the sacral sore recurred or flap failed. Additional available flap is needed either for primary reconstruction or secondary reconstruction. Aim and Objectives: The flap from the gluteal crease derives blood supply from the inferior gluteal artery, but can be subcategorized into three types according to the different terminal branches and flap composition. We tried to use this flap to reconstruct the sacral sore and increase the armamentarium of a plastic surgeon. Materials and Methods: Between June 2005 and May 2008, 10 patients with stage IV sacral sores were reconstructed with flaps from the gluteal crease. The flap is designed over the gluteal crease and harvested as an island flap that is based on the inferior gluteal artery to reconstruct the sacral sore. The average defect size was 120 cm^2 (12×10 cm^2). The average flap size was 86.9 cm2 (10.6×8.2 cm2). Results: All flaps survived completely and the wound healed satisfactorily, except for one flap failure that was converted into V-Y advancement flap. Minor complications included two wound dehiscence in donor sites that required further wound closure, and one flap had temporary flap congestion that resolved spontaneously. These complications were caused by tension resulted from hip contracture in the spastic vegetable patients. Conclusion: The flap from the gluteal crease was a reliable flap that can serve as an alternative choice for primary reconstruction of the sacral sore or a secondary option for salvaging recurrent sacral sore. The flap should be used with caution in patient with hip contracture.