Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region

SummaryThe posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer.