Giant Lumbar Artery Perforator Transposition Flap as a Salvage Strategy for Failed Superior Gluteal Artery Perforator Flap in Near-Total Gluteal Defect following Sacral Malignant Peripheral Nerve Sheath Tumor Resection

In patients with neurofibromatosis type 1 (NF-1), malignant peripheral nerve sheath tumors (MPNSTs) are highly aggressive sarcomas. We report a case of a 33-year-old female with NF-1 who had a recurrence of high-grade MPNST in the sacral region within 1 month of primary wide excision and split-thickness skin grafting. Secondary excision led to a large defect (25 × 20 cm) with an exposed sacrum. The defect was managed with a left-sided superior gluteal artery perforator (SGAP) flap and a right-sided V-Y advancement flap; however, the SGAP flap was discarded intraoperatively due to venous congestion. As a salvage measure, the defect was managed with a left fourth lumbar artery perforator (LAP) transposition flap. Stable coverage was achieved with the LAP transposition flap, while the remaining small defect was managed with a split-thickness skin graft. Thus, the LAP transposition flap is a viable alternative in patients with compromised SGAP flaps for near-total gluteal defect reconstruction of the sacral region.