Buttock Reconstruction in Sarcoma Surgery: An Esthetic Sigmoidplasty Closure for Large Circular Defects Using Double Opposing Skin Flaps

Abstract

Background:Large defects arising from extirpation surgery of buttock sarcomas requiring adjuvant radiotherapy are best closed with flap surgery. The traditional solutions are derived from an approach to pressure sores, which were designed for the ischial, sacral, or trochanteric areas, and have now been adapted for true buttock defects. This invariably destroys the esthetics of the buttock. We describe a novel technique of sigmoidplasty, which preserves most of the esthetic features.Methods:We report on a retrospective review of 11 consecutive buttock sarcomas managed at our institution between 2009 and 2014, focusing on those for which the described reconstruction method was used (N = 5).Results:The immediate outcome was very good. In 1 patient, partial loss of 1 of the flaps and the management thereof resulted in a minor contour deformity. In general, the buttock volume was significantly decreased but the shape was preserved. This was obtained without secondary donor defect and with minimal contour irregularity. Long-term follow-up remained pleasing, and all patients were satisfied with the outcomes.Conclusions:The described technique of buttock defect closure satisfies the oncoplastic principles of tumor surgery with the added benefit of superior esthetics. We suggest that it is a versatile adjunct to the reconstructive surgeon’s armamentarium for buttock reconstruction after sarcoma excision, particularly when the gluteal artery perforator systems are unavailable.

Pacman flap for oncologic reconstruction of soft-tissue defects after tumor resection

“…Skin graft increases the likelihood of donor-site morbidity, color differences, and more time needed for dressing and fixation. Rotational flaps are most commonly used to cover round soft-tissue defects after tumor resection; these include the rhomboid flap, [ 1 , 2 ] double-opposing skin flap, [ 3 ] double-helix rotation flap, [ 4 ] pinwheel flap, [ 5 ] double-scalpel flap, [ 6 ] Limber flap, [ 7 , 8 ] and reading-man flap. These flaps were designed to take advantage of laxity in the surrounding tissue and optimize aesthetic outcomes.…”