Distal perforator-based fasciocutaneous V-Y flap for treatment of sacral pressure ulcers.
Although the gluteal V-Y advancement flap has been recognized as the most reliable method for management of sacral pressure ulcers, its limited mobility has been a challenging problem. The authors present a new modification of the V-Y advancement flap to overcome the problem. After débridement, a large triangle is designed to create a V-Yadvancement flap on the unilateral buttock and the medial half is elevated as a fasciocutaneous flap, preserving the distal perforators in the muscular attachment. Then an arc-shaped incision is made in the gluteus maximus muscle along with the lateral edge of the triangular flap. The split muscle is elevated at a depth above the deeper fascia until sufficient advancement of the flap is obtained. This full-thickness elevation of the gluteus maximus muscle from the distal (lateral) side avoids the impairment of perforators or their mother vessels and achieves great advancement. Thirty-one patients with sacral pressure defects larger than 8 cm in diameter were treated using this surgical procedure. Overall, 93.5 percent of the flaps (29 of 31) healed primarily. The largest defect that was closed with a unilateral flap was 16 cm in diameter. The present technique accomplishes remarkable excursion of the unilateral V-Y fasciocutaneous flap, with high flap reliability and preservation of the contralateral buttock as well as gluteus maximus muscle function.
Ichioka
Shigeru
S
Department of Plastic and Reconstructive Surgery, Saitama Medical School, Japan. ichioka-stm@umin.ac.jp
Okabe
Katsuyuki
K
Tsuji
Shinsaku
S
Ohura
Norihiko
N
Nakatsuka
Takashi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery; D002081:Buttocks / Q000098:blood supply / Q000601:surgery; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D012447:Sacrum; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing / Q000502:physiology