Reconstruction of extensive gluteal defect following excision of hidradenitis suppurativa using a combined lumbar artery perforator and split superior gluteus maximus musculocutaneous flap: A case report

Hidradenitis suppurativa is a chronic, inflammatory, recurrent, debilitating, skin follicular disease characterized by painful nodules and recurrent persistent drainage. Severe hidradenitis suppurativa not only reduces quality of life but also serves as a precursor to squamous cell carcinoma and can cause sepsis; therefore, complete excision of the lesion is recommended. We report a case of extensive hidradenitis suppurativa affecting most of the bilateral buttocks. Since it was determined that the extensive lesion in this case could not be covered in a single stage using any known single flap, we decided to perform reconstruction using a newly devised combined flap. For the area cephalad of the iliac crest, a large rotation flap centered on a lumbar artery perforator was designed. For the area caudal to the iliac crest, the superficial layer of the cephalic portion of the gluteus maximus muscle was split, and a musculocutaneous flap was designed to be elevated to include the perforating branch of the superior gluteal artery. These flaps were elevated as a single combined flap. Postoperatively, the flap blood flow was stable and the graft took well. There was no longer any persistent discharge from the lesion, and no functional impairment was observed following the elevation of the gluteus maximus musculocutaneous flap. Reconstruction using a combined lumbar artery perforator and split superior gluteus maximus musculocutaneous flap was considered a useful method, as the technique is simple and can cover extensive gluteal defects.