Perforator-based bilobed flaps in patients with a sacral sore: Application of a schematic design

Background: Many procedures have been proposed for the treatment of sacral sores, and bilobed flaps are widely used to reconstruct defects of the lower third of the nose. This retrospective study was conducted to evaluate our experiences of bilobed flaps based on parasacral perforators, for the treatment of sacral sores. Methods: Twelve patients, six males and six females, aged 21-74 years (mean age: 51.08 years), with a sacral sore were treated with a bilobed flap at our institution from February 2007 to November 2009. Sacral sores were treated by en bloc excision and defects were closed using a bilobed flap in each case. Flaps were designed using parasacral perforators after considering pocket locations. The average postoperative follow-up duration was 16 months. Results: Primary wound healing was achieved in all patients. Large defects left after excision were easily closed using bilobed flaps, which provided tensionless wound closure. The postoperative courses were uneventful in all 12 cases, and no patient experienced recurrence. Conclusion: The use of a perforator-based bilobed flap enables regional reconstruction using well-vascularised tissues, and provides satisfactory and aesthetic results in sore patients. Furthermore, rerotation is possible in the event of sore recurrence. Accordingly, we consider the perforator-based bilobed flap to be a useful and additional tool for the treatment of pressure sores. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.