2012 Volume 25 Issue 2 Pages 113-118
Free tissue transfer is seldom used for reconstruction of the buttock because of the absence of appropriate recipient vessels in the gluteal area and difficulties in postoperative care in the prone position to prevent impairment of the anastomosed pedicles. We present a patient who underwent treatment for a recurrent radiation ulcer in the sacroiliac joint using free latissimus dorsi musculocutaneous flap nourished by the inferior gluteal vessels.
A 77-year-old woman who had suffered from uterine cancer and osteogenic sarcoma in the pelvis, and had undergone surgical resection and radiation therapy, presented with a radiation ulcer on her right buttock. The ulcer reached the retroperitoneum through the sacroiliac joint, and osteomyelitis was observed. Numerous scars caused by the previous operations were seen around the ulcer. First we tried to treat the ulcer using a split gluteus maximus muscle flap, but it failed due to insufficient obliteration of the dead space. We therefore used a free LD m-c flap supplied by the inferior gluteal vessels in the revision surgery. The patient had to stay in the prone position for two weeks, and the ulcer healed subsequently.
In conclusion, a free LD m-c flap supplied by the inferior gluteal vessels is useful to treat radiation ulcers involving the sacroiliac joint.
