Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap

Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.