Abstract

LLANOS OLMEDO, S. et al. Island miocutaneous gluteus maximus flap for coverage of ischiatic ulcers. Cir. plást. iberolatinoam. [online]. 2006, vol.32, n.1, pp.41-48. ISSN 1989-2055.

The ischiatic ulcers develop as a consecuense of long sitting position. This kind of ulcers relapse in a great percentage and are a challenge for clinicians. Most of the time causes long hospital stays, multiple surgical procedures and complex antimicrobial therapy. Coverage can be done with several myocutaneous flaps, including gluteus maximus, biceps femoris, gracilis, tensor fascia lata, semitendinosus, semimembranosus, etc. In this study we used the myocutenous gluteus maximus flap, in which we incorporate, as a variation, a perforating irrigated cutaneous island with V-Y advancement without tension. Our goal was to demostrate that the myocutaneous gluteus maximus flap could be the first choice procedure in ischiatic ulcers. We propose, as a surgical variant, the complete liberation of the muscle, which provides a wide range of rotation. In adittion, this variant, includes a cutaneous island with V-Y advancement without tension. All of this reduces morbidity and percentage of relapse. Thirteen flaps V-Y advancement and rotation myocutenous gluteus maximus flaps were made to cover grade III and IV ischiatic ulcers. The asociated diseases were tetraplegia y paraplegia due to medular injury and familiar spastic paraplegia. Follow up was from 6 months to 7 years and, to date, no morbidity or relapse has been documented. In our experience the myocutenous gluteus maximus flap would be the firts choice in ischiatic ulcers treatment because of their large volume and abundant irrigation and because of its migration from cefalic to caudal. the closure without tension is due to the complete disecction of the muscle and the cutaneous island V-Y advancement. We assume this is the reason for the absense of relapse and complications.

Keywords : Myocutenous flap; Gluteus maximus flap; Ischiatic ulcer.

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