Lumbosacral defects on 20 patients were covered with a perforator-base
d flap. Cutaneous perforators derived from the 9th and 10th intercosta
l arteries, the 4th lumbar artery, and multiple gluteal perforators th
at penetrate the gluteus maximus muscle were used as vascular pedicles
. Minor complications occurred in five cases. Using this method, minim
al morbidity of the donor site is expected because the gluteus maximus
need riot be sacrificed. Accordingly, perforator-based flaps are espe
cially indicated for ambulatory patients, but for paraplegic patients
as well. Even in the event of recurrence, another perforator-based or
musculocutaneous flap can be elevated fr om the ipsilateral side becau
se of the presence of multiple perforators in the lumbosacral and glut
eal regions.