Paraspinal Transposition Flap for Reconstruction of Sacral Soft Tissue Defects: A Series of 53 Cases from a Single Institute

Abstract

Study DesignCase series.PurposeTo describe paraspinal transposition flap for coverage of sacral soft tissue defects.Overview of LiteratureSoft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature.MethodsThe flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years).ResultsThere was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores.ConclusionsThe authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

The Use of Paraspinal Transposition Flap for Recurrent Pilonidal Sinus, a New Histological Basis for Management of Pilonidal Sinus Disease

“…In conclusion, we think that the used flap, namely, paraspinal transposition graft [5] or transverse lumbar flap [6], is a very good option for treatment of recurrent pilonidal sinus disease based on the new histological finding and explanation of the disease described in this work aiming at elimination of the skin microscopic vulnerability in hirsute males, a fact not addressed by the other commonly used flaps. Not only this but also our suggested flap avoid midline scars and lead to flattening-elevation of the natal as recommended by Scott and his co-workers [11].…”

“…Also, it has been successfully treated by using a highly alkaline seton called kshar sutra, an ancient Indian technique which does not require plastic surgical operation and hospital admission and can be done as office procedure. [13] The skin of the used flap described before [5,6] showed the lack of such vulnerability as compared to the proposed site of other flaps (Fig. 3c, e).…”

“…The ability of the pilonidal sinuses to spread laterally into both gluteal regions [3], governed by the skin vulnerability suggested by Karydakis [4], raise the theoretical probability of a similar skin vulnerability of the donor site from which most of the flaps used for repair of the pilonidal sinus (PNS) are taken including the Karydakis flap itself. The used flap in this study was described before by Gupta et al in 2014 in covering soft tissue defects [5]. Also, it was described by BS Mathur and colleagues in 2016 under the name of transverse lumbar perforator flap in treatment of lumbosacral defects [6].…”

3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection

“…While locoregional flaps are the standard of care in most sacral wound defects, they are not plausible in many scenarios. Numerous local flap options have been reported, including gluteal artery perforator flaps (13–16), gluteus maximus sliding flaps (17), paraspinal flaps (18), V-Y advancement flaps (19, 20), and regional anterolateral thigh flaps (21). However, they are relatively contraindicated in oncological sacral defects.…”