Seoul, Korea; and Singapore From the Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, and the Division of Plastic, Reconstructive, and Aesthetic Surgery, Department of Surgery, National University Hospital.
Plast Reconstr Surg. 2010 Jun;125(6):1744-1751. doi: 10.1097/PRS.0b013e3181cb675f.
The new design of the gluteus maximus perforator-based island flap for coverage of gluteal defects has the distinct advantage of being able to use customizable tissue components for coverage and at the same time sparing the source vessel. This adds a further option for use in reconstruction.
After excisional débridement of the lesion, a perforator adjacent to the defect is selected. The tissue of the donor region is pinched to simulate closure. The change in shape of the recipient defect is noted and the dimensions of this new shape are measured. This will serve as the new dimensions of the donor tissue. The tissue components required to fill the defect are then analyzed and the flap is raised. It can be either muscle-sparing, muscle-splitting, or muscle-inclusive. A 1- to 2-cm diameter of soft tissue around the perforator is preserved. The flap is islanded and transposed, and the donor site is closed primarily, acting as a "locking barrier" to the flap. Tension-free closure of the recipient flap is then carried out. Seventy-five patients underwent closure of varying defects of the gluteal region using this technique.
The authors had a total of three minor complications. The rest of the patients healed well, with no recurrence at a mean follow-up of 15 months.
The flap design for coverage of gluteal defects has a great impact on recurrence and complications. This design is novel and the flap is simple to elevate. This is an ideal flap in any high-risk patient in whom the risk of recurrence is high.
用于覆盖臀区缺损的臀大肌穿支皮瓣的新设计具有明显的优势，即能够使用可定制的组织成分进行覆盖，同时保留供区血管。这为重建增加了另一种选择。
在对病变进行切除清创后，选择紧邻缺损的穿支。夹住供区组织以模拟闭合。注意受区缺损的形状变化，并测量这个新形状的尺寸。这将作为供区组织的新尺寸。然后分析需要填充缺损的组织成分，并掀起皮瓣。它可以是肌保留、肌劈开或肌包含。保留穿支周围 1-2cm 直径的软组织。皮瓣呈岛状转移，供区一期闭合，起到皮瓣的“锁定屏障”作用。然后对受区皮瓣进行无张力闭合。75 例患者采用该技术闭合了不同大小的臀区缺损。
作者共有 3 例轻微并发症。其余患者均愈合良好，平均随访 15 个月无复发。
覆盖臀区缺损的皮瓣设计对复发和并发症有很大影响。这种设计是新颖的，皮瓣易于掀起。对于复发风险较高的任何高危患者，这都是一种理想的皮瓣。
