If additional skin is required to accomplish perineal wound closure without tension, the gluteal thigh flap may be elevated in combination with a gluteal muscle flap based on the same pedicle. The pedicle of the gluteal thigh flap, the descending branch of the inferior gluteal artery can be separated from beneath the gluteal muscle and dissected to its take-off from the inferior gluteal artery as it emerges from underneath the piriformis muscle, allowing independent placement of the muscle in the cavity and the skin paddle on the surface . This technique allows two separate tissue transfers in a single flap procedure and is well suited for patients that require a wider pelvic dissection in addition to an extensive resection of the perineal skin .
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