The modified bilobed flap for reconstructing sacral decubitus ulcers

Abstract

Background Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer. Case presentation We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019. A description of our management, operative protocol, outcome and complications is outlined. Seven paraplegic patients (6 male, 1 female; average age 53.1 years) with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery. The average size of the pressure ulcers was 7 × 5 cm (range 6.2 × 4.5 cm to 11 × 10 cm). All 7 flaps survived. The patients were followed up for 12 months without significant complications, such as flap necrosis or recurrence. Conclusions The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap. The superior cluneal nerve can be included in the design. The technique is simple and reliable. It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.

A Guide to Perforator Flap Selection for Buttock Pressure Sore Reconstruction

“…Bilobed flaps based on parasacral perforators were used for the treatment of sacral sores 23 . Other double or multiple flaps have also been reported for sacral pressure ulcer repair 24,25 . In addition, a mathematically standardized double-bladed perforator flap was designed for sacral pressure sores repair 26 .…”

“…23 Other double or multiple flaps have also been reported for sacral pressure ulcer repair. 24,25 In addition, a mathematically standardized double-bladed perforator flap was designed for sacral pressure sores repair. 26 However, the use of mathematically standardized bilobed design perforator flaps for covering sacral pressure ulcers is debatable as the wound condition is different in cachectic, mobile, or immobile patients.…”