Perforator propeller flaps for sacral and ischial soft tissue reconstruction

Abstract

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications.

Multidimensional Use of Pedicled Gluteal Artery Perforator Flaps in Perianal and Gluteal Regions

“…The SGAP and IGAP flaps provide large bulky and save skinsubcutaneous flap to manage perineal and gluteal soft tissue defects. (10,11). There were no recurrences in the patient cases during the followup period.…”

“…local flaps may develop a slight sensory recover via peripheral innervations. In addition to this condition a myocutaneous flap is still a better choice for filling an extensive cavity when more bulk tissue is indicated (9,10). The SGAP and IGAP flaps provide large bulky and save skinsubcutaneous flap to manage perineal and gluteal soft tissue defects.…”

Effective Salvage Surgery of a Severely Congested Propeller Perforator Flap Using a Postoperative Delay Technique and Negative-Pressure Wound Therapy

“…This flap often causes necrosis (incidence = 9.1% to 25.0%) due to overtension and twisting of perforators. [1][2][3][4][5] Flap necrosis is rarely found in cases of flap rotation of less than 110° but is often found (incidence = 21.4% to 33.0%) in cases of flap rotation of more than 110°. [1][2][3][4][5] The present flap, with a larger flap rotation of 150°, tended to cause poor circulation.…”

“…However, on day 2 postoperatively, flap congestion remained severe, which had a concern due to potential 863513I JLXXX10.1177/1534734619863513The International Journal of Lower Extremity WoundsIshii et al case-report2019 1 International University of Health and Welfare Hospital, Tochigi, Japan 2 Keio University, Tokyo, Japan wide-ranging flap necrosis (Figure 1b). Therefore, we performed an emergency operation under local anesthesia.…”

A simple concept for covering pressure sores: wound edge‐based propeller perforator flap

“…(18) With regards to pressure sores, these flaps have the advantage of being reliable, reducing the operative time and being easy to perform, along with reducing donor site morbidity. (5,(19)(20)(21) In this study, we used the propeller perforator flap model based on newly formed or enlarged perforators located in the chronic wound edge, rather than those based on anatomically well-defined source vessels. Different from the standardised perforator flap concept, we made no particular effort to skeletonise the perforator.…”