Introduction: In sacral pressure ulcers, wound healing is poor and closure is difficult, resulting in complications, such as dissection. Skin flap utilization is the mainstay of treatment for ulcers with concerns regarding dissection and recurrence, intractable pockets, and bone exposure. We selected a perforator-preserving gluteal artery-based fasciocutaneous (FC) rotation flap as the first choice for sacral ulcer reconstruction. In addition to the commonly used back cut and typical Burow's triangle for rotation flaps, we have placed modified Burow's triangles to reduce the size of the second defect and used the deepithelialization technique for suturing ulcers to prevent dissection and recurrence.
In this study, we aimed to describe the usefulness and our ingenuity of the perforator-preserving gluteal artery-based rotation FC flap.
Materials and methods: We evaluated 14 patients with sacral pressure ulcers who underwent surgery. In all patients, the perforator-preserving gluteal artery-based rotation FC flap was used and had good wound bed preparation. The method (unilateral or bilateral, back cut, Burow's triangle, and deepithelialization technique) as well as the postoperative wound dehiscence, infection, epidermal necrosis, small fistula, and recurrence were retrospectively evaluated as outcomes.
Results: A unilobar rotation flap or double-opposing unilobar rotation flap was selected in nine and five cases, respectively. The back cut technique (82.4%), Burow's triangle (42.1%), and deepithelialization technique (100%) were used to close the ulcer. The mean follow-up period was 9.8 ± 6.5 months with no observed cases of wound dehiscence (0%) or infection (0%). Although epidermal necrosis of the wound edge (28.7%) and small fistula (21.4%) were observed, wound closure was achieved conservatively and in a short period of time. No recurrence was observed.
Conclusion: The perforator-preserving gluteal artery-based rotation FC flap can be safely used in cases of sacral pressure ulcer reconstruction when using the back cut, Burow's triangle, and deepithelialization techniques appropriately under fine wound bed preparation.