title: A composite gluteofemoral flap for reconstruction of large pressure sores over the sacrococcygeal region.
abstract: OBJECTIVE
  Gigantic pressure sores pose a daunting challenge for plastic surgeons. This paper presents a composite gluteofemoral flap for reconstruction of large pressure sores over the sacrococcygeal region.
  
  
  METHODS
  In this anatomical study, 30 embalmed cadaveric lower limbs were used for dissection to observe the musculocutaneous perforators of the inferior gluteal artery and the longitudinal nutritional vascular chain of the posterior femoral cutaneous nerve. In this clinical study, eight patients underwent surgical harvest of the composite gluteofemoral flap for coverage of grade IV sacrococcygeal pressure sores. The size of the pressure sores ranged between 16 × 9 cm and 22 × 10 cm.
  
  
  RESULTS
  The inferior gluteal artery was present in 26 cases and absent in four cases. It gave off two to four musculocutaneous branches with a diameter larger than 0.5 mm to the gluteus maximus. A direct cutaneous branch was given off at the inferior margin of the gluteus maximus, serving as a nutritional artery for the posterior femoral cutaneous nerve. The size of the flap harvested ranged between 22 × 9 cm and 32 × 10 cm. Flaps in seven patients survived uneventfully and developed epidermal necrosis at the distal margin in one case. An average 2-year follow-up revealed no recurrence of pressure sores.
  
  
  CONCLUSIONS
  The composite gluteofemoral flap, being robust in blood supply, simple in surgical procedure, and large in donor territory, is an important addition to the armamentarium.
authors.affiliation: First Affiliated Hospital, Fujian Medical University, Fuzhou 350108, Fujian, China. Electronic address: xyxlr@126.com.
authors.forename: Yun
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Anatomic Department, Fujian Medical University, Fuzhou 350108, Fujian, China. Electronic address: zhuangyuehong@163.com.
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Zhuang
authors.affiliation: Anatomic Department, Fujian Medical University, Fuzhou 350108, Fujian, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Xue
authors.affiliation: Anatomical Institution, Department of Orthopedics, General Hospital of People's Liberation Army, Nanjing District, Fuzhou 350108, Fujian, China. Electronic address: hpzheng21012@163.com.
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Zheng
authors.affiliation: First Affiliated Hospital, Fujian Medical University, Fuzhou 350108, Fujian, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D002081:Buttocks / Q000098:blood supply; D002102:Cadaver; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012445:Sacrococcygeal Region / Q000098:blood supply; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome
keywords: Gluteofemoral flap; Pressure sores; Sacrococcygeal; Surgery