The random upper posterior thigh fasciocutaneous flap.

A superiorly based random posterior thigh fasciocutaneous flap has evolved as a coexisting variant of the gluteal thigh composite flap, which is frequently important due to commonly encountered vascular anomalies in this region, such as absence of the descending branch of the inferior gluteal artery. This flap is distinguished by its reliance on the longitudinally oriented axis of the fascial plexus of the upper posterior thigh that is serviced predictably by multiple perforators from the cruciate anastomosis. In a series of 8 such flaps used in 7 patients over the past 10 years, only a single major complication has ensued. Therefore, it has proved to be of tremendous value as another simple, rapidly elevated option to close adjacent ischial or trochanteric defects; it supplements the other known flaps needed here because there is always a high risk of pressure sore recurrence. No muscle needs to be sacrificed, making this flap also a reasonable alternative for the ambulatory patient.