Use of Translocated Deep Inferior Epigastric Vessels for Free Flap Reconstruction of Gluteal Defect

1 Koichi Tomita, MD, PhD Megumi Yokoi-Fukai, MD Takayoshi Ishihara, MD Kosuke Morita, MD Ko Hosokawa, MD, PhD Department of Plastic and Reconstructive Surgery Graduate School of Medicine Osaka University Osaka, Japan Sir: R of large defects in the gluteal region remains challenging. Although regional flaps (eg, anterolateral thigh flap) or myocutaneous flaps (eg, tensor fasciae latae) are options, extensive scarring after multiple surgeries or heavy irradiation renders these options unavailable. In such situations, free flap transfer is often the last resort. Because the gluteal region suffers from insufficient vascular pedi cles, finding reliable recipient vessels is challenging. We herein present a method for reconstructing a large defect in the gluteal region using deep inferior epigastric (DIE) vessels as free flap recipients. A 70-year-old man suffered from recurrent myxoid liposarcoma in the left gluteal region. Multiple tumor resections and radiation therapy (60 Gy, 3x) resulted in a large soft tissue defect (20 × 8 cm). To reconstruct the defect, a free latissimus dorsi myocutaneous (LDM) flap was elevated in the lateral position. Simultaneously, DIE vessels were isolated until they entered the rectus abdominis muscle as a vascular pedicle using a longitudinal abdominal incision. The pedicle was then translocated through a subcutaneous tunnel for anastomosis (Fig. 1). Microsurgical anastomosis was accomplished with ease behind the anterior superior iliac spine in the same position, and the defect was closed with the LDM flap in combination with a skin graft (Fig. 2). The postoperative course was uneventful, and the patient remains ulcer-free after 5 months. The selection of recipient vessels is a critical decision that impacts the success of free tissue transfer. However, options are limited in the gluteal region. Superior and inferior gluteal vessels have been previously used as recipients for free flap reconstruction of a lumbosacral defect.1,2 Although these vessels typically have a sufficient diameter for anastomosis and are near the defect, they can be damaged by multiple surgeries and irradiation, as in the present case. Moreover, Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Plast Reconstr Surg Glob Open 2015;3:e433; doi:10.1097/ GOX.0000000000000413; Published online 23 June 2015. Use of Translocated Deep Inferior Epigastric Vessels for Free Flap Reconstruction of Gluteal Defect