Sacral osteoradionecrosis treated via gluteal artery perforator (GAP) flap

Abstract

Radiation is an important tool in curative or adjuvant therapy for a wide range of malignancies. With the increasing application of radiation, a number of patients display complications, e.g., hypoxic ulcers. When a radiation-induced skin ulcer does occur, the injury tends to be much deeper. If the ulcer involves the underlying skeleton, osteoradionecrosis and subsequent osteomyelitis result. Standard surgical dictum for the treatment of radiation-induced tissue damage follows two basic tenets: (1) removal of all altered tissues to the level of satisfactory blood supply; and (2) provision of suitable coverage. Vascular- and volume-rich flaps are essential to ensure adequate blood supply, fill dead space, and provide soft tissue coverage. Several flaps consistent with these requirements have been documented; however, most are technically challenging and relatively invasive for elderly patients. This report describes the utility of the gluteal artery-based perforator flap to treat a radiation-induced, infected sacral non-healing ulcer.