Interdigitating Fasciocutaneous Gluteal V-Y Advancement Flaps for Reconstruction of Sacral Defects

Abstract

The authors describe a modification of the classic gluteal bilateral V-Y advancement flap for sacral defect closure. After initial debridement, the V-Y design is marked on both sides of the defect. The incision is carried down to the fascia of the underlying gluteus maximus muscle. The upper and lower arms of the flaps are elevated and advanced on the gluteal muscle toward the midline, interdigitating each opposing arm. The overall result is a zigzag, broken midline suture. This procedure was carried out in 14 patients with sacral pressure sores and in 1 patient with a chronic pilonidal sinus. All flaps survived without major problems. There were no recurrences during the 6 to 16 months of follow-up. The interdigitating fasciocutaneous V-Y gluteal flap design is effective in breaking the midline vertical scar and preserving the gluteus maximus muscle.

The Use of Suture Anchors in Reconstruction of Sacral Pressure Ulcers With Gluteal Fasciocutaneous Advancement Flaps

“…Natal cleft recreation is particularly important in young female paraplegic patients, who always seek and wish for a superior esthetic result. [12][13][14]20,21 Possible disadvantages of suture anchors use could be (1) foreign body reaction, leading to inflammation or infection; and (2) iatrogenic trauma to the terminal filum of the cauda equine during tunnel creation on the midline of the sacrum. To diminish the risk of the aforementioned complications, absorbable anchors with minimal dimensions (2.0-ϫ 9.7-mm drill bit) were used, and the holes were drilled on the processes of the median sacral crest to maximize the distance to the sacral canal.…”

Improvisations in classic and modified techniques of flap surgery to improve the success rate for pressure ulcer healing in patients with spinal cord injury

“…This helped to close a circular defect by advancing subcutaneous pedicle triangular flaps. Ay et al (26). used the arms of the flaps in the form of interdigitating fasciocutaneous gluteal V‐Y flaps so that more healthy tissues were included in the midline, further advancement was possible, final closure was broken and the zigzag closure decreased the tension on the midline suture over the sacrum without injury to gluteus maximus muscle.…”

“…Ay et al (26) used the arms of the flaps in the form of interdigitating fasciocutaneous gluteal V-Y flaps so that more healthy tissues were included in the midline, further advancement was possible, final closure was broken and the zigzag closure decreased the tension on the midline suture over the sacrum without injury to gluteus maximus muscle. All flaps survived without major problem except in one patient in whom superficial necrosis occurred in the distal end of one arm of the flap; the wound healed without necessitating a secondary operation (26). In the present study, we performed interdigitating gluteus maximus V-Y advancement flap in five patients with multiple dermal incisions on flap surface and achieved excellent results.…”

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

“…The use of local tissue is the ideal for like-with-like replacement, but donor site availability may be a limiting factor. The traditional surgical procedures (eg, fasciocutaneous V-Y flap, 1,2 gluteus maximus, 3,4 inferior gluteal artery perforator 5 and superior gluteal artery perforator 6 flaps, gluteal/posterior thigh flap, 7 tensor fascia lata flap, 8 and fasciocutaneous infragluteal flap 9 ) may satisfy this need. These flaps have been developed for free-flap harvest and pressure sores.…”