Pedicled fasciocutaneous flap of multi-island design for large sacral defects.

UNLABELLED: We designed a new pedicled fasciocutaneous flap for large sacral defects that combined a classic superior gluteal artery perforator flap and an acentric axis perforator pedicled propeller flap. We asked whether this technique would be simple and result in few complications. Six patients with large sacral defects had reconstruction using this technique in one stage. The size of the defect and postoperative complications in each patient were assessed. The minimum followup was 6 months (mean, 20.1 months; range, 6-38 months). All wounds healed with no recurrence during followup. Five patients achieved healing primarily, and another with minimal drainage achieved healing by secondary intention after a dressing change. No patients had deep infection, wound dehiscence, necrosis, or partial loss or shrinkage of the flap at final followup. The buttocks were symmetric. We consider this a good alternative for reconstructing large sacral defects because it is a relatively simple procedure and results in few complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[An effect of multi-island flap with shallow branch of gluteus upper artery on repair of sacrum soft tissue defect].

OBJECTIVE: To explore a safe, highly-efficient and rapid approach to the repair of the sacrum soft tissue defect and/or partial exposure of the bone. METHODS: From February 2003 to April 2006, 6 patients (4 males, 2 femals; aged 28-67 years) with the sacrum soft tissue defect were surgically treated by the multi-island flap with shallow branches of the gluteus upper artery. The soft tissue defects ranged in area from 15 cm x 12 cm to 25 cm x 20 cm, averaged 20 cm x 16 cm. The obtained flaps ranged in area from 18 cm x 15 cm to 30 cm x 25 cm. Of the patients, 5 had a sacral ulcer (Grade III in 3 patients, Grade IV in 2) and 1 had a tumor, with their illness course from 3 weeks to 20 years. RESULTS: All the flaps survived completely in the 6 patients, in whom 5 had an incision healing of the first intention, and the remaining 1 had a healing of the second intention 32 days after the treatment for the minor ischemia and necrosis at the edges of the flap. The follow-up for 2-38 months (average, 19.3 months) revealed that all the flaps grew well with no recurrence of the sacral ulcer. CONCLUSION: The surgical treatment with the multi-island flap with shallow branches of the gluteus upper artery is a safe, highly-efficient and rapid approach to repair of the sacrum soft tissue defect and/or partial exposure of the bone. This kind of treatment has advantages of simpler procedures, better blood circulation of the flap, fewer complications, and higher success rates.