Tangentially Split Gluteus Maximus Myocutaneous Island Flap Based on Perforator Arteries for the Reconstruction of Pressure Sores

Learning Objectives: After studying this article, the participant should be able to: 1. Describe a new, partial-thickness, tangentially split myocutaneous flap based on perforating vessels from the superior and inferior gluteal arteries. 2. Present indications for the use of the tangential myocutaneous gluteus perforator flap in pressure sore management. 3. Discuss results of flap use in 30 patients with pelvic pressure sores from paraplegia and other debilitating illnesses. 4. Emphasize the ability to use the flap in ambulatory patients without loss of gluteus maximus function. From 1995 to 1997, the authors used tangentially split gluteus maximus myocutaneous island flaps based on the musculocutaneous perforator arteries for the reconstruction of pressure sores located in the trochanteric, sacral, and ischial regions of 30 ambulatory and paraplegic patients. The postoperative follow-up period was 18 months. Postoperative electromyograms were performed on the ambulatory patients to compare the function of the gluteus maximus muscles on each side. There were one major and two minor postoperative complications. There was no total flap loss. The major advantage of this technique is the preservation of most of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. The tangentially split gluteus maximus myocutaneous island flap is recommended as the procedure of choice for closure of sacral, ischial, and trochanteric ulcers in both the ambulatory and nonambulatory patient. (Plast. Reconstr. Surg. 103: 2071, 1999.)