Flap selection for sacral pressure ulcer

Despite advances in reconstructive techniques, the surgical treatment of pressure ulcers is a challenge to the plastic surgeon. The flap used for coverage of sacral ulcers should be as large as possible and flap design should not violate adjacent flap territories. Various designs of local flaps, gluteal fasciocutaneous and musculocutaneous flaps are commonly used. Few studies have attempted to compare the efficacy of one flap with another. The fasciocutaneous flap seems to provide a better long-term result than the myocutaneous flap, because of low tolerance for ischemic injury. Local flaps are the first choice for small sacral pressure ulcers. To obtain sufficient blood supply, the local flap can be raised as a perforator based flap. Hie fasciocutaneous flaps are transposed as an island flap or V-Y advanced flap. In the V-Y advancement flap, distal gluteal perforators are secured and the insertion of the gluteus maxi-mus is divided if needed. The island gluteal perforator flap based on the parasacral perforators can be rotated up to 180 degrees. If the higher perforators are included, the degree of rotation can be minimized. Closed drains are left and wounds are closed in layers. The patient is nursed on a high performance bed for 3 weeks before gradual mobilization.