Reconstruction of Defect Adjacent to the Buttock with Gluteal Perforator Flap: Free Style Flap Design

PURPOSE: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. METHODS: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. RESULTS: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. CONCLUSION: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

Gluteal Perforator Flaps for Coverage of Sacral Pressure Sores

PURPOSE: Gluteal perforator is easily identified in the gluteal region and gluteal perforator flap is a very versatile flap in sacral sore reconstruction. We obtained satisfying results using the gluteal perforator flap, so we report this clinical experiences with a review of the literature. METHODS: Between November of 2003 and April 2006, the authors used 16 gluteal perforator flaps in 16 consecutive patients for coverage of sacral pressure sores. The mean age of the patients was 47.4 years (range, 14 to 78 years), and there were 9 male and 7 female patients. All flaps in the series were supplied by musculocutaneous arteries and its venae comitantes penetrating the gluteus maximus muscle and reaching the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus arising from gluteal muscles. Patients were followed up for a mean period of 11.5 months. RESULTS: All flaps survived except one that had undergone total necrosis by patient's negligence. Wound dehiscence was observed in three patients and treated by secondary closure. There was no recurrence during the follow-up period. CONCLUSION: Gluteal perforator flaps allow safe and reliable options for coverage of sacral pressure sores with minimal donor site morbidity, and do not sacrifice the gluteus maximus muscle and rarely lead to post- operative complications. Freedom in flap design and easy-to perform make gluteal perforator flap an excellent choice for selected patients.

Treatment of Romberg`s Disease Using Superior Gluteal Perforator-based Flap

Romberg's disease manifests as progressive hemifacial atrophy of skin, soft tissue, and bone. Treatment involves three-dimensional reconstruction of all soft- tissue and skeletal disturbances. Soft-tissue reconstruction is directed at augmentation of deficient soft-tissue volume and there are many therapeutic modalities available, such as autologous tissue grafts and inorganic implants. The arrival of microsurgical techniques has improved the outlook for facial contour restoration. The tissues used for microsurgical tissue transfer include groin, scapular, and omentum. This article introduces our experience with the superior gluteal perforator-based flap for the restoration of facial contour defects in the patient of Romberg`s disease. Superior gluteal perforator flap has some advantages; It doesn`t need to transect or sacrifice of the gluteus maximus muscle, Flap elevation time is short, Blood flow of the perforator is reliable, There is no post-operative hindrance to walking in patient. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for tedious dissection.