Reconstruction Of Sacral Defects Research Articles

Using Superiorly Located Perforator Based Parasacral Perforator Flaps For Reconstruction of Sacral Defects

Using Superiorly Located Perforator Based Parasacral Perforator Flaps For Reconstruction of Sacral Defects

The use of perforator flaps for the reconstruction of sacral defects

Background: Despite advances in reconstruction techniques, sacral defects continue to challenge surgeons. The perforator flap preserves the entire contralateral side as a future flap donor site and the gluteal muscle itself on the ipsilateral side to minimize donor-site morbidity. Materials and Methods: Between April 2003 and March 2013, data obtained from 60 patients with sacral defects reconstructed with perforator flaps were retrospectively analyzed. Results: We analyzed the sacral defects reconstructed with three different perforator flaps into the following groups: group 1, 30 patients with superior gluteal artery perforator flaps, (average flap size was 83.8 cm2); Group 2, 19 patients with parasacral perforator flaps (average flap size was 94.2 cm2); and Group 3, 11 patients with inferior gluteal artery perforator flaps (average flap size was 85.8 cm2). The overall flap survival rate was 93.3% (56/60). Conclusion: Perforator flaps are a reliable option for soft-tissue defect reconstruction as they provide a sufficient amount of tissue to cover large sacral defects. We recommend perforator flaps as a viable alternative in the management of sacral defects that cannot be reconstructed with primary closure or local fasciocutaneous flaps.

Partially De-epithelised Gluteus Maximus Myo-facio-cutaneous Advancement Flap Cover: A Newer Reconstructive Option for Sacral Defects

Pressure sores or infected pilonidal sinus resulting into sacral defect is a challenge in view of reconstruction frequently faced by a plastic surgeon. Many flaps have been proposed for the same out of which muscle and myocutaneous flaps are associated with better surgical outcome due to its durable coverage and superior blood supply. In this current study, we introduce a novel technique of partially de-epithelised Gluteus maximus myo-facio-cutaneous advancement flap cover for sacral defects resulting due to bedsores as well as pilonidal sinus. This study was conducted from April 2016 - April 2017, a total of 30 patients underwent reconstruction of sacral defects post pilonidal sinus excision as well as grade 3-4 bed sores. Post-operatively the flaps were evaluated in terms of incidence of flap necrosis, infection, rate of healing, aesthetic outcome and rate of recurrence. All 25 flaps healed with fair post-operative outcome with no significant complications. Thus, partially de-epithelised Gluteus maximus myo-facio-cutaneous advancement flap cover efficiently reconstructs sacral defects and proves to be a safe, durable option with excellent aesthetic outcome.

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage.

Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection

BackgroundWhile performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes.MethodsBetween February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2).ResultsWe assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17–43 days) vs. 16.82 days (range 13–21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000–4,000 mL) vs. 1,733 mL (range 1,500–2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05).ConclusionsThe use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.

Reconstruction of sacral defects following necrosis of buttocks due to embolization of internal iliac artery using a transverse lumbar flap

Fractures of the pelvis associated with uncontrollable hypotension are managed by stabilization of fractures and arteriographic embolization of the bleeding vessels. Embolization of these arteries may result in necrosis of the buttocks. The use of a transverse lumbar artery-based flap can be used for repair of these defects.

Reconstruction of sacral defects following necrosis of buttocks due to embolization of internal iliac artery using a transverse lumbar flap

Fractures of the pelvis associated with uncontrollable hypotension are managed by stabilization of fractures and arteriographic embolization of the bleeding vessels. Embolization of these arteries may result in necrosis of the buttocks. The use of a transverse lumbar artery-based flap can be used for repair of these defects.

Outcomes for Reconstruction of Sacral Defects Using Superior Gluteal Artery Perforator Flaps: Comparison with Random Pattern Fasciocutaneous Flaps

Outcomes for Reconstruction of Sacral Defects Using Superior Gluteal Artery Perforator Flaps: Comparison with Random Pattern Fasciocutaneous Flaps

Outcomes for Reconstruction of Sacral Defects Using Superior Gluteal Artery Perforator Flap: Comparison with Random Pattern Fasciocutaneous Flaps

Outcomes for Reconstruction of Sacral Defects Using Superior Gluteal Artery Perforator Flap: Comparison with Random Pattern Fasciocutaneous Flaps

Interdigitating fasciocutaneous gluteal V-Y advancement flaps for reconstruction of sacral defects.

The authors describe a modification of the classic gluteal bilateral V-Y advancement flap for sacral defect closure. After initial debridement, the V-Y design is marked on both sides of the defect. The incision is carried down to the fascia of the underlying gluteus maximus muscle. The upper and lower arms of the flaps are elevated and advanced on the gluteal muscle toward the midline, interdigitating each opposing arm. The overall result is a zigzag, broken midline suture. This procedure was carried out in 14 patients with sacral pressure sores and in 1 patient with a chronic pilonidal sinus. All flaps survived without major problems. There were no recurrences during the 6 to 16 months of follow-up. The interdigitating fasciocutaneous V-Y gluteal flap design is effective in breaking the midline vertical scar and preserving the gluteus maximus muscle.