Perforator propeller flaps for sacral and ischial soft tissue reconstruction.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Sacral and ischial pressure sores present significant reconstructive challenges.
• Perforator-based flaps offer a promising alternative to traditional reconstructive methods.
• These flaps utilize perforators from the gluteus maximus muscle for rich vascularization.

Purpose of the Study:

• To evaluate the efficacy and outcomes of perforator-based propeller flaps in reconstructing sacral and ischial defects.
• To assess the complication rates associated with these reconstructive techniques.

Main Methods:

• Retrospective review of 11 patients undergoing reconstruction for sacral pressure sores, ischial pressure sores, or pilonidal sinus.
• Flap design based on superior gluteal, parasacral, or inferior gluteal artery perforators.
• Propeller flap technique utilized for soft tissue coverage.

Main Results:

• Six sacral pressure sores reconstructed with superior gluteal and parasacral artery perforator flaps; one flap loss (16.7%).
• Three ischial pressure sores reconstructed with inferior gluteal artery perforator flaps; one flap with infection and dehiscence (33.3%).
• Two pilonidal sinus cases reconstructed with parasacral perforator flaps; both survived without complications (0%).

Conclusions:

• Perforator-based propeller flaps are effective and suitable for soft tissue reconstruction in the sacral and ischial regions.
• These flaps demonstrate minimal donor site morbidity and preserve gluteus maximus muscle function.
• Further investigation may be warranted to optimize outcomes and minimize complications in specific patient populations.