[Covering sacral and ischiatic loss of substance with musculocutaneous flaps]

Eschars located in the sacral and ischiatic areas raise problems of recovering when much tissue has been lost. The usual techniques, such as dermoepidermal grafts or local skin flaps, are difficult to perform and have a high failure rate. In contrast, musculo-cutaneous flaps are excellent both to fill and to cover the raw areas. Three types of flap have been used successfully by the authors in 12 consecutive patients, some of whom had paraplegia. Two of them involve the greatest gluteal muscle which is divided into two heads according to blood supply. The "butterfly" flap uses the upper heads of the two muscles, on either side of the midline, with the corresponding skin territories ; it is most useful to cover wide sacral areas. In the "pendular" flap, the lower head of one of the greatest gluteal muscles is mobilized to cover a moderate loss of tissue in the ischiatic area. Finally, the "kite" flap concept is based on bringing up the ischio-crural muscles to cover wide ischiatic eschars.