title: Free transverse rectus abdominis myocutaneous flap reconstruction of a massive lumbosacral defect using superior gluteal artery perforator vessels.
abstract: Despite significant advances in reconstructive surgery, the repair of massive lumbosacral defects poses significant challenges. When the extent of soft tissue loss, tumor resection, and/or radiation therapy preclude the use of traditional local options, such as gluteal advancement flaps or pedicled thigh flaps, then distant flaps are required. We report a case of a 64-year-old male who presented with a large sacral Marjolin's ulcer secondary to recurrent pilonidal cysts and ulcerations. The patient underwent wide local composite resection, which resulted in a wound measuring 450 cm(2) with exposed rectum and sacrum. The massive defect was successfully covered with a free transverse rectus abdominis myocutaneous flap, providing a well-vascularized skin paddle and obviating the need for a latissimus flap with skin graft. The free-TRAM flap proved to be a very robust flap in this situation and would be one of our flaps of choice for similar defects.
authors.affiliation: Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA 94304-5715, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Gaster
authors.forename: Kirit A
authors.initials: KA
authors.lastname: Bhatt
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Shelton
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D002081:Buttocks / Q000098:blood supply; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000150:complications*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation*; D012878:Skin Neoplasms / Q000209:etiology / Q000601:surgery*