[Musculocutaneous island flap using the upper gluteus maximus muscle]

The authors report 24 cases treated with an gluteus maximus musculocutaneous flap. The gluteus maximus is generally used as a VY flap. Our technique uses the superior part of the muscle with the overlying skin as a rotation flap. The upper part of the muscle is supplied by the superior gluteal artery. A good knowledge of the anatomy makes this flap easy to perform. The skin part of the flap is drawn over the trochanter. It is generally a 8 cm diameter circle. We then create a subcutaneous tunnel to prepare the rotation. The muscle is then freed from its lateral origin. The separation from the gluteus medius is made by blunt dissection and the superior gluteal artery can then be seen. The myocutaneous flap can now be raised and transferred to the defect. This flap has, in our experience, many advantages especially in paraplegic patients: large skin defects can be covered with a single flap, the perisacral skin is free of any scar, the lower part of the muscle can still be used to cover ischial ulcers. Since 1987 we have treated 24 patients with good results. The reliability and the great technical simplicity makes us think that the superior gluteus maximus musculocutaneous island flap is optimal for the coverage of sacral pressure sores.