الفهرس 
Anatomy of gluteal regionOnly 14 pages are availabe for public view
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Abstract
The gluteus maximus myocutaneous flap is a useful, safe and versatile flap for the repair of sacral decubitus ulcers. It may be recommended as the procedure of choice for the surgical treatment of this type of wound .Pressure sore (PS), bedsores and decubitus ulcer have the same meaning used to describe ischemic tissue loss resulting from prolonged pressure over bony prominence . They can develop anywhere in the body , but often located in the trochanteric , ischia, heel , and sacral areas Decubitus ulcers term derived from Latin decumbere, to lie down occur over areas that have underlying bony prominences when the patient is recumbent, e.g., the sacrum, trochanter, heel, and occiput. Terms such as bedsore or decubitus ulcer should be avoided as they suggest all the sores are a result of supine positioning. Although tissue destruction can occur over areas like the sacrum, scalp, shoulders, calves, and heels when a patient is lying down, the ischial sores occur in wheelchair-bound patients who are sitting, making “pressure sore” the better term .Gluteal region mainly supplied by superior and inferior gluteal arteries which are branches of internal iliac artery.(fig.2) Gluteal perforator flaps are designed based on the perforators in the above 2 arteries .National pressure sore advisory conference classified pressure sores into 4 stages from stage 1 to stage 4 and unstageable pressure sores , Aim of the workThe purpose of the work is to describe our experience in management of sacral pressure sore with gluteus maximus myocutaneous flap , its feasibility and outcome .Patient and Method Our prospective study will be conducted in General Surgery Department of Benha University Hospital after an approval from the research ethics committee in Benha Faculty of Medicine and all patients will sign informed consents that they will be involved in this study.Inclusion criteria:Clean sacral pressue sore or dirty sore after aperiod of debridment medically or surgically .Audible superior and inferior gluteal arteries by Doppler .No ischemic manifestations .ulcer away from anus in fecal incontinernce or colostomy will be done before .Good general condition to withstand anaethesia and healing process .No osteomyelitis by x-ray .Management :
In general , optimum management of bed sores begins with prevention by optimizing nutrition status , eradication of infection , relieving pressure and minimizing other contributing factors .Pressure sores stges 1&2 can be treated conservatively by using optimal non-surgical ulcer treatment and by eliminating the local and general conditions that interfere with healing .While PS stages 3&4 usually require surgical intervention. Non-surgical management of can be rendered by enzymatic debridment using urea and collagenase amongst other enzymes over the wound .In addition , adjuvant treatments for pressure ulcers has noticeable role including use of newer technology to improve wound healing e.g vacuum therapy , hyperbaric oxygen , lasers , ultrasound , electrotherapy While surgical management of bed sores includes debridment including Chemical debridment e.g dakin solution and mechanical debridment using dressings changes along with wound cleansing and Surgical debridment by excision of ulcer , underlying bursa and calcifications .It also includes surgical flaps . Musculocutaneous flaps as gluteus maximus myocutaneous flaps has many advantages as they can be revised or readvanced if recurrence occurs and that sutures don’t lie on pressure zone and those flaps Can fill in undermined ulcers with skin removal .Follow up:Low residue diet , Kept in a prone or lateral position. Periodic turning in bed was started immediately. Negative suction was continued until the collection of fluid stopped i.e. about 2 - 3 weeks post operatively Patients were followed up initially monthly for 3 months, every 3 months for a year and then half yearly .