CASE REPORT Soft tissue coverage of a total gluteal defect with a combination of perforator-based flaps: A case report Mario F. Scaglioni MD | Vendela Grufman MD | Matteo Meroni MD | Elmar Fritsche MD Depatment of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland Correspondence Mario F. Scaglioni, MD, Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Spitalstrasse 6000 Luzern 16, Lucerne, Switzerland. Email: mario.scaglioni@gmail.com Abstract Soft tissue defects in the buttock area are often related to decubitus ulcers, which are usually small to medium-large size and can be regularly treated with local flaps. However, when the defects have bigger size, such as those involving the whole glu- teal region, the coverage can become more challenging, since this specific area needs both a good resistance to pressure and an acceptable functional result. The most common solution for similar cases is the use of multiple local flaps, or, in extreme sit- uations, a free flap. In particular, local flaps based on perforator vessels are, in selected cases, a consolidated alternative to free flap allowing an efficient recon- struction of soft tissue defects using adjacent similar tissues, providing the benefit of “like with like” coverage. Here we present a case of a large mycosis fungoides nidus of the gluteal region measuring 25 cm × 18 cm reconstructed using two large perfo- rator flaps adjacent to the defect combined with a remote one for coverage of the donor site. The cranial flap was designed based on a perforator arising from the supe- rior gluteal artery and transferred into the defect by means of a V–Y advancement, while the two caudal propeller flaps in the posterior thigh were both based on perfo- rators of the profunda femoris artery and rotated 180  , respectively. To obtain a tension-free cover of the donor site defect we applied the concept of “sequential” propeller flaps. Post-operative course was uneventful and the patient was ambula- tory with assistive devices after 1 week. At 6 months follow-up, wounds were completely healed without complications and a good functional result was obtained. This report showed the great coverage potential of multiple perforator-based local flaps when properly combined allowing primary closure of the donor site. In particu- lar, we managed to reconstruct a total gluteal defect using just ipsilateral side tissue, reducing morbidity, and obtaining a stable result. 1 | INTRODUCTION Even if vast tissue defects still represent a challenge to the recon- structive surgeons, the progress in the anatomical comprehension of vascular territories and perforator vessels permitted the introduction of several types of local perforator pedicled flaps (Nakajima, Fujino, & Adachi, 1986; Taylor, 2003). This can be specifically applied to the buttock region when large defects have to be restored and non- conventional approaches are required. The most common and most discussed lesions in this area are the decubitus ulcers that are usually treated by using local flaps. However, sometimes bigger defects are Mario F. Scaglioni and Vendela Grufman contributed equally to this study and should be considered co-first authors. Received: 15 November 2019 Revised: 1 April 2020 Accepted: 4 May 2020 DOI: 10.1002/micr.30605 Microsurgery. 2020;1–5. wileyonlinelibrary.com/journal/micr © 2020 Wiley Periodicals, Inc. 1