Design and application of a pedicled lumbogluteal fasciocutaneous flap based on the fourth lumbar artery perforator and neurotrophic vascular network

To explore the anatomy and design of a lumbogluteal fasciocutaneous flap with a pedicle based on the fourth lumbar artery perforator and neurotrophic vascular network. Based on the anatomic findings of the lumbogluteal region in 15 human cadavers, a special lumbogluteal fasciocutaneous flap was successfully designed. This flap was then confirmed applicable in 12 patients for repairing extensive sacrococcygeal wounds. The mean external diameter of the posterior branch of the fourth lumbar artery at the fascial penetration point was 1.16 ± 0.43 mm. Nineteen of 30 sides (63.3%) were single trunk artery branches, while the fourth lumbar artery in 11 sides (36.7%) was divided into 2–3 branches before perforating the deep fascia. The size of the designed flap varied from 17.4 cm × 12.5 cm to 25.4 cm × 18.3 cm, covering a large area. All the flaps survived, but one patient developed partial wound dehiscence which was managed conservatively. The designed flap is simple in design. When used to repair large sacrococcygeal wounds, all the flaps survived.