Trilobed pedicled superior gluteal artery perforator flap for lumbosacral defect coverage

There are many available options for the coverage of lumbosacral area defects. Surgeons usually use the superior gluteal artery perforator flap (SGAP) by rotational fashion, which risks complications, such as wound dehiscence or skin necrosis at the Y-point on the donor site due to the tension. In this report, the authors present the experience of using trilobed pedicled SGAP flaps in coverage of the lumbosacral area defects.

From 2011 to 2015, 16 trilobed pedicled SGAP flaps were performed for the coverage of sacral defects in our facility. The average defect sizes were 9.3 cm × 7.4 cm (ranging from 5 cm × 4 cm to 13 cm × 13 cm ). Trilobed flap were designed to include a reliable perforator vessel and rotated 90 degrees to the defect. All flaps included only one perforator vessel.

The average of flap sizes were 15.9 cm × 9.2 cm (ranging from 10 cm × 20 to 5 cm × 15 cm). Two cases of minimal distal margin necrosis (<1 cm) were reported in the flap tip area. The unviable distal area was completely healed after the excision and primary closure. All flaps survived completely. Patients were followed for an average of 14.8 months postoperatively (ranging 6-20 months). There was no recurrence of the pressure sore during the follow-up period.

Trilobed pedicled SGAP flap successfully reconstructed various sized defects and reduced the distortion and tension of the wound, minimizing wound complications. This flap could reduce the hospital stay and the recurrence of the pressure sore.