Sensate superior gluteal artery perforator flap for reconstruction of sacrococcygeal large wound dehiscence: A case report and literature review.

Abstract

The superior gluteal artery perforator (SGAP) flap is an option for the reconstruction of deep sacral defects. Since a conventional SGAP flap is not neurotized, covered ulcers have a risk of recurrence, especially when patients cannot ambulate by themselves. In ambulatory patients, the sensory presentation of reconstructed tissue assures its protection. Purpose of this report is to present a case of the use of a sensate SGAP flap for reconstruction of a sacrococcygeal large wound dehiscence in a patient and review of literature for sensate reconstruction of sacral defects. A 72-year old woman with a sacrococcygeal large wound dehiscence measuring 12 cm in length, 9.5cm in width and 5cm in depth was treated. The defect was caused by a wound dehiscence after abdomino-perineal resection for rectal cancer. A unilateral SGAP flap measuring 16 × 7cm length and 5cm width was designed in the right buttock and the cranial border of the flap was lined near the iliac crest. An SGAP flap was elevated including the superior cluneal nerve (SCN), turned clockwise 70°, and inset to the defect. The defect remained in the deep caudal part a parasacral adiposal flap measuring 7 × 10 cm was harvested from the contralateral side and filled the defect. The postoperative course was uneventful without any complication. Sensation was observed immediately after surgery. Postoperative Semmes-Weinstein monofilament test showed 3.22 at 9months postoperatively. There was no recurrence during follow-up of 20 months. The sensate SGAP flap may be elevated with SCN and be considered for reconstructions of deep sacral defect.