title: Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction.
abstract: BACKGROUND
  Gluteal perforator flaps (GPFs) are the most useful for gluteal region pressure sore reconstruction. However, application is difficult if the surrounding area has scar tissue from previous operations or trauma, especially with recurrent sores. We describe the use of modified lumbar artery perforator flaps when GPFs cannot be used.
  
  
  METHODS
  Between May 2009 and April 2014, 51 patients underwent gluteal pressure sore reconstructions with gluteal (n = 39) or modified lumbar artery (n = 12) perforator flaps. Patients in the modified lumbar artery perforator group had scar tissue from trauma or previous surgery. In this retrospective review, we analyzed patient age and sex, defect size and location, operative time, follow-up duration, immediate postoperative issues, flap necrosis, dehiscence, re-operation, donor-site morbidity and recurrence. Complications and clinical outcomes were compared between groups.
  
  
  RESULTS
  We found no significant differences in patient demographics, surgical complications or clinical outcomes. There were eight cases of temporary congestion (20.51%) and four of partial flap necrosis (10.25%) in the gluteal perforator group. In the modified lumbar artery perforator group, there were three cases of temporary congestion (25%) and one of partial flap necrosis (8.33%). No pressure sores recurred during follow-up in either group.
  
  
  CONCLUSIONS
  GPFs are the gold standards for gluteal pressure sores, but modified lumbar artery perforator flaps are relatively easy and useful when GPFs cannot be used due to scar tissue.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Chi Sun
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji Hong
authors.initials: JH
authors.lastname: Yim
authors.affiliation: Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Ha
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000637:transplantation*; D002081:Buttocks / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061525:Perforator Flap / Q000098:blood supply* / Q000592:standards / Q000637:transplantation*; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply* / Q000592:standards / Q000637:transplantation*; D016896:Treatment Outcome
keywords: gluteal region; perforator flap; pressure ulcer; reconstructive surgical procedure; surgical flaps