The "split" gluteus maximus musculocutaneous flap.

The "split" gluteus musculocutaneous flap is a useful flap for perineal and ischial reconstruction. The flap uses the superficial 1 to 2 cm of the gluteus muscle, supplied by proximal parasacral perforators. It can be raised simply, quickly, and with minimal blood loss. Importantly, the deep muscle is left in place and remains innervated and well-vascularized. Deep structures are protected, and other flap options are preserved. Anatomic findings based on 16 cadaver dissections (8 cadavers with bilateral dissections) are presented. Representative case reports and our experience with 18 consecutive cases in 17 patients are presented.