BACKGROUND: Defects in the buttock region are frequent indications for plastic surgery and are caused by various mechanisms. Therefore, different flaps were introduced and are well established. However, all of them have their limitations in reconstruction because of their restricted arc of rotation. Hence, we indicated the use of the local fasciocutaneous infragluteal (FCI) flap for reconstruction of such defects in the buttock region. METHODS: In a series of 14 patients, three of them being paraplegics, the authors used 15 local FCI flaps to cover defects in the buttock region. The defects were caused by pressure sores, pilonidal sinus infection with recurrence, an adenocarcinoma of the gluteal region, a massive abscess after intramuscular gluteal injection, lipodystrophy of the lateral gluteal region and by multiple operations after an infection of implanted hip-joint prosthesis. RESULTS: The median dimension of the flaps was 177 cm(2). Fourteen of the 15 flaps healed uneventfully. In one patient, a re-mobilisation of the flap was necessary after a minor, distal-flap necrosis. Closure of the donor site was possible in all patients without further trouble. One patient needed a second local FCI flap because of a new pressure sore on the contralateral sacral region. CONCLUSIONS: The FCI flap is not only a versatile and reliable free flap with different indications, but is also a good alternative as a local flap for defect reconstruction in the whole buttock region, as demonstrated in this study for the first time. It can be raised as a sensate flap without restrictions of mobility in ambulatory patients. The donor-site morbidity is minimal, and options for future flaps of the gluteal region are preserved.
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