Buried Superior Gluteal Artery Perforator Flap for Dead Space Coverage in the Sacral Area

Partial sacrectomy is a common treatment for sacral sarcomas, which often results in a large defect and exposed rectal wall. The defect could be covered using a gluteus maximus (GM) advancement flap. However, seroma and wound dehiscence are often observed after GM advancement flap coverage, delaying the wound healing process. We present a case of buried superior gluteal artery perforator (SGAP) flap following GM muscle splitting. An 11-year-old male patient with epithelioid sarcoma in the sacrum underwent partial sacrectomy. The sacral defect size was 9×6 cm, and the GM muscle was intact. We designed a 7×4-cm elliptically-shaped SGAP flap skin paddle, after which perforator dissection was performed underneath the GM muscle. To minimize dead space, the GM muscle was split and the flap was de-epithelized and advanced to the posterior rectal wall. There were no wound complications during admission and the patient was discharged on postoperative day 16. No atrophy of the flap was found on postoperative magnetic resonance imaging, either. This case demonstrates that using a buried SGAP flap for covering dead space could be a good surgical method to cover wide sacral defects.