[Covering of chronic sacral ulcers by myocutaneous gluteus maximus island flaps]

Experience with 18 cases of chronic sacral ulcers treated with gluteus maximus island flaps and a review of perioperative managements are presented. Sacral pressure sores in immobile patients sometimes require radical surgery. Suitable cover can be obtained by myocutaneous island flaps. In seven patients defects up to six cm in diameter were covered by unilateral gluteus maximus myocutaneous island flaps. Eleven defects up to 17 cm in diameter were closed by bilateral gluteus maximus island flaps. The donor sites were closed primarily by direct approximation. There was no flap necrosis. In two patients wound dehiscence occurred and in another two there was delayed wound infection. In one infected case a fistula became established and this was treated by further excision and advancement of the flaps. In all cases suitable healing with adequate padding was obtained. There has been no recurrence of ulceration after two years.