Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction

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Excerpt

Pressure sores occur on protruding hip regions of immobilized patients, mainly in the sacral, coccygeal or ischial regions. The flap coverage can only cure pressure sores in the context of high quality pressure care and ancillary treatment. Various local flaps are used for reconstruction according to pressure sore location. Traditionally, V‐Y gluteus maximus advancement flaps have been used for sacrococcygeal region reconstruction; inferior gluteus maximus island flaps, inferior gluteal thigh flaps or gracilis flaps have been used for ischial lesion reconstruction. Recently, various perforator flaps have been used for gluteal lesion reconstruction, with less donor‐site morbidity compared to that with muscle flaps or musculocutaneous flaps.1 Because there are many gluteal region perforators, gluteal perforator flaps (GPFs) are used as the primary method of reconstruction in that area.1 However, sores often recur due to patient comorbidity. Reconstruction of recurrent sores has proven challenging for reconstructive surgeons, primarily due to flap choice, for which sufficient healthy tissue is needed; this is particularly difficult in the gluteal region due to scar tissue from previous operations or trauma. A free flap may be considered, but free‐flap surgery has multiple disadvantages, such as the need for a skilled micro‐surgeon, possibility of flap failure and the amount of time required. Here, to overcome limited GPF selection, we modified lumbar artery perforator flaps (MLAPFs) based on previous reports.
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