Reconstruction of large sacral pressure ulcers with the double-opposing distal perforating superior gluteal arteries-based fasciocutaneous V-Y advancement flap

Objective We designed a double-opposing distal perforator-based fasciocutaneous V-Y advancement flap method for closing a large sacral pressure ulcer.The purposes of our method were to obtain sufficient advancement and to avoid a functional deficit of the gluteus maximus muscle.Methods After debriderment,the V-Y advancement flap is marked on the bilateral buttock.A fasciocutaneous flap is elevated from the medial part,preserving the distal perforating superior gluteal arteries in the distal muscular attachment of the gluteus maximus muscle until sufficient advancement of the flap is obtained.Results Fifteen patients with sacral pressure defects between 7～15 cm in diameter were treated using this surgical procedure.The results showed no flap necrosis and recurrence in any patient,and 91% percent of the flaps healed primarily.Conclusions The present technique accomplishes remarkable excursion of the bilateral V-Y fasciocutaneous flap,with high flap reliability and preservation of the contralateral buttock as well as gluteus maximus muscle function.