[Perineal complications and gracilis musculocutaneous flap in patients with paraplegia. Apropos of 19 cases].

The authors reviewed the indications for gracilis musculocutaneous flap in paraplegic patients with an ischial pressure sore. After analysing the causes and types of perineal complications associated with this type of pressure sore, it would appear that this flap should be used more widely to prevent essentially urethral complications. The many advantages are emphasised: thickness of the flap, urethral protector muscle, large amount of good quality skin cover, ample rotation arc, especially as an island flap, easy closure of the donor site, preservation of the posterior musculocutaneous capital of the thigh. However, despite these advantages, the drawback, responsible for the poor reputation of this flap, must not be over-looked: the poor contiguity between the muscle volume and the volume of skin cover. The surgeon is therefore able to transform a disadvantage into an advantage by respecting rigorous technical rules.