Safe and easy way to reconstruct pressure ulcers: Gluteal artery perforator flaps

Abstract

Introduction: Pressure ulcers continue to be a reconstructive challenge due to the growing number of patients under risk. Frail nature of the affected patient makes this problem even more complicated. Commonly pressure ulcers are reconstructed with random pattern flaps or musculocutaneous flaps. With the emergence of the perforator concept and expanding knowledge in the vascularity of the gluteal integument, gluteal artery perforator flaps became popular in reconstructing pressure ulcers. In this study, we aimed to review the technical tips to improve clinical outcomes of superior gluteal artery perforator and inferior gluteal artery perforator flaps in the light of our clinical experience. Materials and Methods: Between 2015 and 2018, nine patients with pressure ulcers in the sacral and ischial regions were reconstructed with gluteal artery perforator flaps. Anatomical landmarks were marked, and Doppler ultrasound was also used to identify individual perforators. The subfascial dissection was opted, and skin island was inseted resembling an advancement pattern to prevent peforator kinking and to include maximum number of perforators. Results: All flaps survived, seroma was seen in two patients, and two of the patients had wound dehiscence at donor site. Conclusions: In the era of perforator flaps, with their safe anatomical basis, less morbidity and versatility in design we offer gluteal artery perforator flaps as a reliable alternative in reconstructing pressure ulcers.