• Hyeokdong Kwon, Chang Hwan Ahn, Sunje Kim, Joo-Hak Kim, Hyun Woo Kyung, Seung Han Song, Sang-Ha Oh, Ho Jik Yang, and Yooseok Ha.
• Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea.
• Medicine (Baltimore). 2022 Sep 16; 101 (37): e30615e30615.

AbstractMany various types of operative techniques have been performed used to treat make-up for sacral defects. Perforator-based flaps with flap transposition, but achieving an optimal flap design and tension-free flap closure without skeletonizing the perforator requires a great deal of clinical experience. In this study, we demonstrate perforator selection based on considerations of the relaxed skin tension line (RSTL), which has proven to be a suitable method of achieving an efficient flap design that enables primary closure. Twenty-five perforator-based flap procedures were performed on 25 patients at a single institution from February 2018 to January 2021. The medical records of patients were retrospectively reviewed. Twenty-three flaps survived completely. Two flaps developed partial tip necrosis but recovered after secondary healing, and 1 patient developed temporary congestion, which resolved spontaneously. No recipient or donor site recurrence or dehiscence was identified during follow-up. We report our clinical experiences of perforator-based flap use in the sacral region. When selecting an appropriate perforating vessel, 2 important points should be considered, that is, a flap long axis parallel to RSTLs and defect shape. According to the method presented in this paper, perforator-based flaps can be transposed safely and easily with few complications and serve as useful practice models to cover sacral defects.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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