Gluteus Maximus Muscle and Musculocutaneous Flap

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The gluteus maximus muscle is one of the largest muscles in the body. Its principle actions are to extend the thigh and assist in its lateral rotation, steady the thigh and assist in raising the trunk from the flexed position. It has a dual blood supply from the superior and inferior gluteal vessels. The inferior gluteal artery and posterior cutaneous nerve of the thigh supply the inferior portion of gluteus maximus and the skin of the posterior thigh. Excision of the lower aspect of the gluteus maximus results in no functional deficit; the donor site can be closed primarily and the muscle is sufficiently bulky to fill the cavity [16]. Baird et al. reported a series of 16 patients in which the inferior gluteal myocutaneous flap was employed to close large perineal wounds [33], all but one patient achieved complete healing of the perineal wound. In addition, Gottlieb and Jejurikar [18] prefer the inferior gluteus maximus muscle. To facilitate exposure, dissection and elevation of the lateral distal aspect of the inferior gluteus maximus muscle from the ileotibial tract, a counter-incision is made in the upper lateral posterior thigh. By detaching the origin and insertion of the inferior portion of the glu-teus maximus muscle, leaving it attached only by its vascular pedicle, the flap will be able to fill the dead space of very large and deep perineal and pelvic

Gluteus Maximus Flap

Fig. 3. The gluteus maximus musculocutaneous flap wounds (Fig. 3). Bell et al. [34] think that this flap cannot fill the pelvis deeply and reserve this technique for patients in whom a chronic sinus occurs after primary simple closure of the perineal wound. This has the important advantage of avoiding re-entering the pelvic cavity from the abdomen.

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