Split Gluteus Maximus Musculocutaneous Islanded Flap Based on Inferior Gluteal Artery for All Sacral Sore Management: A New Technique

Background Surgical management of sacral sore has always been a challenge. Majority of the cases are encountered in patients with spinal cord injuries due to poor nursing care. Numerous flaps are described for resurfacing these defects. However there is high rate of failure leading to recurrence due to multiple factors. The most common being lack of tension free lie of the flap once it is advanced. To avoid this one is forced to raised two flaps from the either side of the sacral defect. This limits the option of future flap harvest in case there is a complication. These drawbacks can be circumvented by using a new technique. Split gluteus maximus musculocutaneous islanded flap based on inferior gluteal artery is a robust vascular flap with better reach ensuring tension free lie, and at the same time due to its ability to cover defects of any size, no second flap is needed to be raised from the other buttock. Materials and Methods 20 Cases of sacral sores were included in the study. All these patients had sustained spinal cord injuries at various levels who had earlier undergone decompression and fracture fixation/ stabilization procedures. Recurrent sacral sores following flap cover were also included in the study. However the pressure sores in ventilator dependent moribund patients due to any medical or surgical cause were excluded from the study. In all these cases resurfacing of the sacral defects were carried out using split gluteus maximus musculocutaneous islanded flap based on inferior gluteal artery. Adequate dissection of the inferior gluteal artery pedicle ensured sufficient mobilization of flap across the midline. Tension free lie of the flap was therefore accomplished. Patients were managed in prone and lateral position post operatively. Results There were no flap loss. No recurrence of sacral sore was detected once the patients were made to lie supine or wheel chair bound and followed up for 01 year post operatively. The gluteal contour bilaterally remained same with adequate bulk on the operated side comparable with the non operated side. Conclusion The split gluteus maximus musculocutaneous islanded flap based on inferior gluteal artery can therefore be considered a superior viable option to resurface sacral sore of any dimension without sacrificing the superior half of the muscle and without any need of contra lateral flap elevation for tension less covering of the defect.