Anatomical basis and clinical application of the infragluteal perforator flap.
BACKGROUND
When selecting flaps for coverage of pressure ulcers of the sacrum and perineal region in paraplegic patients, long-term high recurrence rates should be considered. Therefore, the authors developed an infragluteal perforator flap to avoid "burning bridges" for future reconstruction.


METHODS
Infragluteal perforator flaps were dissected in five fresh human cadavers to define the anatomy of the cutaneous branches of the descending branch of the inferior gluteal artery and cluneal nerves and define anatomical landmarks for clinical application. In a series of 13 paraplegic patients, the authors used perforator-based flaps (additional skin bridge) to cover four perineal ulcers and one sacral ulcer and perforator flaps to cover six perineal and two sacral ulcers. Donor sites were closed by direct approximation.


RESULTS
Twelve of 13 flaps healed uneventfully. In all cadaver and clinical dissections, one or two cutaneous branches of the descending branch of the inferior gluteal artery and one or two cluneal nerves were found at the lower border of the gluteus maximus muscle supplying the infragluteal perforator flap. These direct cutaneous branches allowed dissection of inferior gluteal perforator flaps with improved flap mobility compared with the perforator-based flaps. The descending branch of the inferior gluteal artery could always be spared for future flaps.


CONCLUSIONS
The infragluteal perforator flap is a versatile and reliable flap for coverage of ischial and sacral pressure sores. It can be designed as a perforator-based or perforator flap and could provide a sensate flap in ambulatory patients. Donor-site morbidity is minimal, and options for future flaps of the gluteal and posterior thigh region are preserved.
Scheufler
Oliver
O
Basel and Nottwil, Switzerland; and Durham, N.C. From the Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Basel; Swiss Paraplegic Center; and Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center.
Farhadi
Jian
J
Kovach
Steven J
SJ
Kukies
Sebastian
S
Pierer
Gerhard
G
Levin
L Scott
LS
Erdmann
Detlev
D
D000328:Adult; D000368:Aged; D002081:Buttocks / Q000033:anatomy & histology / Q000473:pathology* / Q000601:surgery*; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications; D003668:Pressure Ulcer / Q000145:classification / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013557:Switzerland