THE GLUTEUS MAXIMUS MUSCLE-SPLITTING MYOCUTANEOUS FLAP FOR TREATMENT OF SACRAL AND COCCYGEAL PRESSURE ULCERS

We describe a modified technique using the gluteus maximus muscle as a splitting myocutaneous nap to close specifically low sacral and coccy geal pressure ulcers. Twenty-eight patients with sacral or coccygeal s tage IV pressure ulcers (average size 4 X 4 cm) underwent a gluteus ma ximus muscle-splitting myocutaneous flap when conservative treatment f ailed to heal the ulcer. Twenty-seven of the 28 patients had complete healing of the pressure ulcer site at an average follow-up of 15 month s (range 2 to 40 months). Complications occurred in 7 patients, requir ing revision of the flap in 2 patients. The advantages of this techniq ue include reduced blood loss, preservation of most of the gluteus max imus for future use, and retained function of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. We r ecommend the gluteus maximus muscle-splitting myocutaneous flap as the procedure of choice for closure of small low sacral or coccygeal ulce rs in both the ambulatory and nonambulatory patient.