title: A new technique of "double-A" bilateral flaps based on perforators for the treatment of sacral defects.
abstract: BACKGROUND
  Myocutaneous and fasciocutaneous flaps can provide stable coverage of sacral defects. For neurologically intact patients, sensate innervated gluteal artery perforator flaps are the ideal solution. For patients with spinal cord injury, soft-tissue coverage can be performed with a variety of noninnervated flaps.
  
  
  METHODS
  Between 1997 and 2004, the authors operated on 30 patients, 21 men and nine women, using bilateral gluteal distal fasciocutaneous and proximal musculocutaneous vertical vector rotation-advancement flaps, based on perforators with V-Y closures. The ages of the patients ranged from 32 to 74 years. Twenty-five patients had spinal cord injuries and all had sacral pressure sores extending to the bone. Three patients had low-grade malignant tumors (sacral chordomas); one had a sacral radiation-induced necrosis and two senile patients with large sacral defects had chronic renal failure and multiple sclerosis. No comorbidities were found in the sample.
  
  
  RESULTS
  All the lesions were closed successfully. After follow-up of 1 to 8 years, 27 patients never required repeated surgery after wound complications. Three patients had infection and partial dehiscence of the flaps that healed after reoperation with V-Y readvancement; three died as a result of their primary diseases.
  
  
  CONCLUSIONS
  This flap design has been used only in selected cases because, after its elevation, use of other gluteal-based flaps for future sacral reconstructions may not be possible. Five neurologically intact patients were found to have good sensitive protection of the flaps and adequate cushion contour after surgery because the authors conserved the gluteal arteries, perforators, and their corresponding sensory nerves.
authors.affiliation: Santiago, Chile From the Division of Plastic Surgery, School of Medicine, Clinical Hospital J. J. Aguirre, University of Chile.
authors.forename: Arturo
authors.initials: A
authors.lastname: Prado
authors.forename: Claudia
authors.initials: C
authors.lastname: Ocampo
authors.forename: Stefan
authors.initials: S
authors.lastname: Danilla
authors.forename: Gustavo
authors.initials: G
authors.lastname: Valenzuela
authors.forename: Sergio
authors.initials: S
authors.lastname: Reyes
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Guridi
mesh_terms: D000328:Adult; D000368:Aged; D002081:Buttocks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012445:Sacrococcygeal Region / Q000601:surgery*; D013524:Surgical Flaps