Yun Xie1, Yue-Hong Zhuang2, Lan Xue3, He-Ping Zheng4, Jian-Hua Lin5. 1. First Affiliated Hospital, Fujian Medical University, Fuzhou 350108, Fujian, China. Electronic address: xyxlr@126.com. 2. Anatomic Department, Fujian Medical University, Fuzhou 350108, Fujian, China. Electronic address: zhuangyuehong@163.com. 3. Anatomic Department, Fujian Medical University, Fuzhou 350108, Fujian, China. 4. Anatomical Institution, Department of Orthopedics, General Hospital of People's Liberation Army, Nanjing District, Fuzhou 350108, Fujian, China. Electronic address: hpzheng21012@163.com. 5. First Affiliated Hospital, Fujian Medical University, Fuzhou 350108, Fujian, China.
Abstract
BACKGROUND AND AIM: Gigantic pressure sores pose a daunting challenge for plastic surgeons. This paper presents a composite gluteofemoral flap for reconstruction of large pressure sores over the sacrococcygeal region. METHODS: In this anatomical study, 30 embalmed cadaveric lower limbs were used for dissection to observe the musculocutaneous perforators of the inferior gluteal artery and the longitudinal nutritional vascular chain of the posterior femoral cutaneous nerve. In this clinical study, eight patients underwent surgical harvest of the composite gluteofemoral flap for coverage of grade IV sacrococcygeal pressure sores. The size of the pressure sores ranged between 16 × 9 cm and 22 × 10 cm. RESULTS: The inferior gluteal artery was present in 26 cases and absent in four cases. It gave off two to four musculocutaneous branches with a diameter larger than 0.5 mm to the gluteus maximus. A direct cutaneous branch was given off at the inferior margin of the gluteus maximus, serving as a nutritional artery for the posterior femoral cutaneous nerve. The size of the flap harvested ranged between 22 × 9 cm and 32 × 10 cm. Flaps in seven patients survived uneventfully and developed epidermal necrosis at the distal margin in one case. An average 2-year follow-up revealed no recurrence of pressure sores. CONCLUSION: The composite gluteofemoral flap, being robust in blood supply, simple in surgical procedure, and large in donor territory, is an important addition to the armamentarium.
BACKGROUND AND AIM: Gigantic pressure sores pose a daunting challenge for plastic surgeons. This paper presents a composite gluteofemoral flap for reconstruction of large pressure sores over the sacrococcygeal region. METHODS: In this anatomical study, 30 embalmed cadaveric lower limbs were used for dissection to observe the musculocutaneous perforators of the inferior gluteal artery and the longitudinal nutritional vascular chain of the posterior femoral cutaneous nerve. In this clinical study, eight patients underwent surgical harvest of the composite gluteofemoral flap for coverage of grade IV sacrococcygeal pressure sores. The size of the pressure sores ranged between 16 × 9 cm and 22 × 10 cm. RESULTS: The inferior gluteal artery was present in 26 cases and absent in four cases. It gave off two to four musculocutaneous branches with a diameter larger than 0.5 mm to the gluteus maximus. A direct cutaneous branch was given off at the inferior margin of the gluteus maximus, serving as a nutritional artery for the posterior femoral cutaneous nerve. The size of the flap harvested ranged between 22 × 9 cm and 32 × 10 cm. Flaps in seven patients survived uneventfully and developed epidermal necrosis at the distal margin in one case. An average 2-year follow-up revealed no recurrence of pressure sores. CONCLUSION: The composite gluteofemoral flap, being robust in blood supply, simple in surgical procedure, and large in donor territory, is an important addition to the armamentarium.
Authors: Haoyang Duan; He Li; Hongying Liu; Hong Zhang; Na Liu; Qingjun Dong; Zhenlan Li Journal: Medicine (Baltimore) Date: 2020-05 Impact factor: 1.889