The Gluteal Artery Perforator Sparing Gluteal Fasciocutaneous Rotation Advancement Flap with V-Y Closure

Yun, Byung Min

Abstract

PURPOSE
The management of gluteal wound originated with burn is same as pressure sore. Pressure sores are managed surgically with two therapeutic components. One is a gross and sharp debridement and the other is a flap providing well-vascularized tissue to cover wounds. Central to the flap considerations is the tendency for recurrence mainly due to a poor blood supply, failure of tension-free closure and naive nursing care after operation, when reconstructive surgeons employ numerous surgical techniques in sores repair. The author used the gluteal artery perforator sparing and gluteal fasciocutaneous rotation advancement flap with V-Y closure to manage gluteal wound originated from burn.
METHODS
Three cases of gluteal wound were treated with the gluteal artery perforator sparing gluteal fasciocutaneous rotation advancement flap with V-Y closure. The skin incision of conventional gluteal rotation flap is shortened to get a minimized flap size and adapts an advancement flap in a back cut pattern, supported laterally with V-Y closure for a tension-free closure. This superiorly (or inferiorly) based flap is elevated subfascially until one or two large musculocutaneous perforators of the inferior gluteal artery are encountered. The perforator down to its emergent point at the level of the piriformis muscle is dissected intramuscularly by splitting fibers of the gluteus maximus muscle in order to pivot freely. Then, the dead space is obliterated with a portion of the gluteus muscle transposed independently. The skin paddle is rotated to the defect area with the saved perforator(s) and closed the defect area.
RESULTS
This technique encompasses the advantages of a perforator sparing flap, a fasciocutaneous rotation flap and an advancement flap with V-Y closure, providing a better vascularity, the flexibility of rerotation in the event of recurrence, preservation of the gluteus maximus muscle for ambulatory function, tension-free mobilization. Compared with other flaps which are previously used to manage pressure sores, one advantage is noted that the minimized operation wound is effective not only to improve the quality of patient's life in terms of position care but also to mitigate the associated wound- healing problems.
CONCLUSION
This technique can be chosen primarily for management of various types of gluteal region wound including burn.