Perforator Flaps after Excision of Large Epidermal Cysts in the Buttocks
A 77-year-old diabetic male visited our outpatient clinic complaining of a mass on the right ischium that had been growing for 11 years. Two years previously, he had undergone incisional drainage of the cyst at a local clinic, but after a year, the cyst had recurred and had grown even bigger. He was admitted for surgery, and the mass was removed under general anesthesia (). The defect measured 2.5 cm×4 cm at its outer surface with a 6-cm internal pocket. The defect was sufficiently small for primary closure, but there was a considerable amount of dead space resulting from the excision of the mass. To fill this dead space, a perforator near the defect was identified, and a PBIF 9 cm×4 cm in size was elevated from the buttock and used to cover the defect. First, the pivot point was closed; then, the remaining donor site was closed; and thereafter, the partially de-epithelized flap was inset to obliterate the dead space. Negative suction drainages were positioned at the donor site, and Dermabond (Ethicon) was applied to the flap to save it from contamination by fecal material. The patient was followed up for 9 more months, and there were no complications or recurrences ().