Reconstruction of the sacral region using the lumbo-gluteal sensory flap

Kimura, Hiroaki; Nasu, Wakako; Kashiwa, Katsuhiko; Kobayashi, Seiichiro

doi:10.1016/j.bjps.2012.08.047

Cited by 11 publications

(10 citation statements)

References 8 publications

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“…2,10,15,24 Reported rates of wound dehiscence and surgical-site infections range from 0% to 66.7%. 8,23 Within our own cohort of 9 patients, we observed 4 cases (44%) of postoperative wound infection and dehiscence.…”

Section: Gluteal Flapmentioning

confidence: 73%

Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)—or 5 of 5 patients not lost to follow-up (100%)—were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

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Section: Gluteal Flapmentioning

confidence: 73%

Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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“…Previous studies have reported high complication and pressure ulcer recurrence rates after conventional reconstruction up to 46.4% (Chiu et al, 2017) and 37.5% (Kuwahara et al, 2005), respectively. Kimura et al reported that the absence of sensation in the transferred flap contributes to pressure ulcer recurrence (Kimura et al, 2013). Therefore, reconstruction with a sensate perforator flap would theoretically be ideal.…”

Section: Discussionmentioning

confidence: 99%

“…However, the superior gluteal artery perforator (SGAP) flap is possibly the most commonly used flap as it preserves the gluteus maximus and does not cause postoperative hindrance to walking (Koshima et al, 1993; Verpaele et al, 1999). However, one of the shortcomings of SGAP flap is lack of sensation, which is an important risk factor for pressure ulcer development and recurrence as well as delayed wound healing (Kimura et al, 2013; Santanelli Di Pompeo et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases

et al. 2021

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The superior gluteal artery perforator (SGAP) flap is a widely used flap for sacral reconstruction. However, it is non‐sensate flap and sensory loss is one of the most important risk factors for pressure ulcer development and recurrence; therefore, a sensate SGAP flap would be ideal for the reconstruction. Because the upper buttock is innervated by the superior cluneal nerves (SCNs) which originate from Th11 to L4, a sensate SGAP flap based on SCNs is anatomically possible. Herein, we present a novel sensate SGAP flap based on SCNs for reconstruction of sacral defects. Two patients with a sacral defect underwent reconstruction using a sensate SGAP flap (53 and 56 years old, both men). Diagnoses were sacral spindle cell sarcoma and sacral pressure ulcer. The defect sizes were 16 × 13 and 12 × 11 cm. The flap was designed based on the locations of SCNs which are commonly located at 6–8 cm lateral from the midline at the iliac crest. Flap sizes were 16 × 9 and 15 × 13 cm, respectively. The flaps survived completely in both cases. Flap sensation was observed immediately after surgery except in flap margins. However, sensory recovery occurred in these areas as well several months postoperatively. None of the patients developed postoperative pressure ulcers during the follow‐up period of 37 and 13 months. This method may preserve flap sensation and therefore can contribute to reducing the risk of postoperative pressure ulcers and could be a useful option for sacral reconstruction.

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“…SCN-innervated flaps for sacral defect were reported using the pedicled lumbar artery perforator (LAP) flap (Kimura H et al, 2013;de Weerd L et al, 2002). As LAP pedicle lied far from the defect, the flap had to be designed larger.…”

Section: Discussionmentioning

confidence: 99%

Sensate superior gluteal artery perforator flap for reconstruction of sacrococcygeal large wound dehiscence: A case report and literature review

Tsukuura

Yamamoto

2021

Microsurgery

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The superior gluteal artery perforator (SGAP) flap is an option for the reconstruction of deep sacral defects. Since a conventional SGAP flap is not neurotized, covered ulcers have a risk of recurrence, especially when patients cannot ambulate by themselves. In ambulatory patients, the sensory presentation of reconstructed tissue assures its protection. Purpose of this report is to present a case of the use of

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Reconstruction of the sacral region using the lumbo-gluteal sensory flap

Cited by 11 publications

References 8 publications

Soft-tissue reconstruction after total en bloc sacrectomy

Soft-tissue reconstruction after total en bloc sacrectomy

Sacral defect reconstruction using a sensate superior gluteal artery perforator flap based on the superior cluneal nerves: A report of two cases

Sensate superior gluteal artery perforator flap for reconstruction of sacrococcygeal large wound dehiscence: A case report and literature review

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