Reconstruction of the Recurrent Ischial Sore with Modified Gluteus Maximus Myocutaneous V-Y Advancement Flap

PURPOSE: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue has been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V-Y advancement flap from buttock can be successfully used in these circumstances. METHODS: From February 2007 to October 2008, modified gluteus maximus myocutaneous V-Y advancement flaps were performed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V-shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. RESULTS: The patients' mean age was 46.9 and the average follow-up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long-term results were satisfied in proper soft tissue bulk and low recurrence rate. CONCLUSIONS: The modified gluteus maximus myocutaneous V-Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.

THE CLINICAL USES OF GLUTEUS MAXIMUS MYOCUTANEOUS FLAPS

Ulcer in buttock is mainly a pressure sore, which is frequently occurred at the sacral region in Korea and its surgical treatment is chiefly the operation using gluteus maximus myocutaneons flaps. For the treatment of ulcerated lesion in gluteal area, various methods using gluteus maximus muscle have been developed. We reviewed and analyzed the 100 cases using gluteus maximus myocutaneous flaps in our department since 1980. The results were summarized as follows ; 1) The ratio between male and female was 3:1. 2) The prevalent age groups were between third and fifth decades. 3) The main cause was the trauma. 4) The wound culture showed the pattern of mixed infections in most cases, consisting of Staphylociccus, Pseudomonas, Enterococcus, Streptococcus, and others. 5) The postoperative complications were noted in about thirty percent of the cases. The complications were flap tip necrosis, wound infection, wound disruption, and others. 6) For the treatment of small ulcers, a pure skin flap or myoplasty may be used, but for the treatment of large one, a kind of myocutaneous flap should be selected. 7) Gluteus maximus myocutaneous flaps can be used as variable methods, but of which the island flap is ideal in deep and large ulcerated lesion.

Gluteus Maximus Myocutaneous Flaps for Repair of the Sacral Pressure Sores / 대한정형외과학회잡지

It would be naive to assume that any operative procedure is the solution to the problem of sacral pressure sore in the field of the orthopaedic surgery. The procedures outlined here involve the creation of compound myocutaneous flaps of the gluteus maximus muscle, skin, and the subcutaneous tissue. The myocutaneous flap us- ing the gluteus maximus muscle is a vascular flap instead of a random flap, with better blood supply for healing and advantage of an increased amount of cushion effect. We present an alternative method which will provide satisfactory and substantial soft tissue coverage in sscral pressure sores.