Experience with the island inferior gluteal thigh flap compared with other local flaps for the reconstruction of the pelvic area.

The pelvic area can be one of the most difficult areas in the body to reconstruct. We divide pelvic wounds into three functional categories: spinal cord injury with no sensation or motor function, spinal cord injury with partial sensorimotor function, and miscellaneous injury, such as that resulting from congenital causes, trauma, or tumor resection. We have found the posterior thigh, particularly the island inferior gluteal thigh flap, to be an excellent choice for all three types of wounds, with the added advantages of sensate coverage and sparing of ambulation musculature in patients for whom such aspects are important. We have found that designing flaps based on the vascular territories of major blood vessels--the angiosome approach described by Taylor and Palmer--provides an excellent and reliable flap for most wounds in the pelvic area. In most patients, the major source vessel is the inferior gluteal artery and the flap is taken as an island flap. When this is not possible or when the island flap does not offer an advantage, we have chosen other local flaps. Our report covers our experience with 36 such procedures in 31 patients, with follow-up ranging from 3 months to 2 years.