Modification of the gluteus maximus V-Y advancement flap for sacral ulcers: the gluteal fasciocutaneous flap method.

We designed a modified gluteus maximus V-Y advancement flap method for closing a sacral ulcer. The purposes of our method were to simplify the surgical procedure and to avoid a functional deficit of the gluteus maximus muscle that was sacrificed by the conventional method. After excising the sacral ulcer, the V-Y advancement flap is marked on the bilateral buttock. Fascial incision of the gluteus maximus is made at the same incision in the skin. One-third of each medial flap is elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle at the parasacral region. The flaps are then moved medially and sutured. We operated on 24 patients with sacral ulcers using this technique. The patients included 19 with a sacral pressure sore and 5 with a radiation ulcer on the sacrum. Eighteen ambulatory patients also were included in this group. The results showed no flap necrosis in any patient. No functional deficit of the gluteus maximus muscle was observed postoperatively in the ambulatory patients. Average blood loss was 250 ml during the procedure. We conclude that the gluteus V-Y advancement flap as a fasciocutaneous flap is superior to the conventional musculocutaneous flap method.