Efficacy analysis of bilateral gluteus muscle flap and skin flap layered advancement closure for reconstructing stage IV sacral pressure ulcer/injury

Pressure ulcer/injury (PU/PI) is serious wounds that are costly to treat. Reconstructive surgery is usually reserved for deep or hard-to-heal cases of stage III and IV ulcers. Following surgical debridement, local flaps are frequently used to fill the wound cavity. Surgical treatment of PU/PI is challenging for high recurrence rates. Our study evaluates the use of bilateral gluteus muscle flap and skin flap layered advancement closure to reconstruct the sacral PU/PI. We performed a retrospective analysis of patients with stage IV sacral PU/PIs treated with our bilateral gluteus muscle flap and skin flap layered advancement closure from March 2019 to March 2022. A description of our management, operative protocol, outcome and complications is outlined. Seven patients (four male, three female average age 52 years) with small or medium size stage IV sacral PU/PIs were treated with bilateral gluteus muscle flap and skin flap layered advancement closure. The average size of the PU/PI was 8.6 × 6.4 cm (range 4 × 4 cm to 12 × 8 cm). All seven flaps survived. The patients were followed up average for 12 months (from 6 months to 24 months). Cosmetic results were satisfactory, with no surgical site breakdown or recurrence of PU/PI in any of the cases. Advantages of this technique include simplicity, reliability, and low risk of recurrence. This viable method of repairing small to medium-sized sacral stage IV PU/PI permits a safe and complete primary closure without undue tension and with respect of cosmetic principles.