The Perforator-Sparing Buttock Rotation Flap for Coverage of Pressure Sores

Abstract

The rotation fasciocutaneous flap for buttock pressure sore coverage has the distinct advantage of allowing rerotation in the event of ulcer recurrence. The authors describe their approach of preserving and incorporating musculocutaneous perforators into the conventional rotation design. The skin incision is the same as that for the conventional gluteal rotation flap. The flap is elevated subfascially until one or two large musculocutaneous perforators of the superior or inferior gluteal arteries are encountered. Intramuscular dissection by splitting fibers of the gluteus maximus muscle is then performed to free the perforator down to its emergent point at the level of the piriformis muscle to enable the perforator to pivot freely with the rotation of the skin flap. Further elevation of the flap beyond the location of the perforator is then performed as necessary to enable tension-free rotation of the skin flap into the defect. Muscle to fill dead space when needed is raised as a separate flap. Seven patients underwent closure of buttock pressure sores in the sacral, ischial, and trochanteric areas using this technique. All wounds healed, with no recurrence, at a mean follow-up of 30 months. This technique can be used to cover pressure sores over the sacral, trochanteric, and ischial regions. This modification of the conventional rotation flap affords the flexibility of rerotation in the event of ulcer recurrence while providing the flap with enhanced blood supply. This is an ideal flap for patients in whom the risk of ulcer recurrence is high.