V-to-Y advancement flap for sacral pressure-induced injury

The patient was referred for a nonhealing stage IV pressure-induced injury over the sacrum (A) that developed during hospitalization for a 60% TBSA burn injury. Two-stage debridement and coverage was accomplished using bilateral V-to-Y advancement flaps (B). Note the position of the inferior gluteal artery perforator on the right flap (X in panel B), and the size of the flaps. The leading edge of the right-sided flap was de-epithelialized and used to augment the strength and durability of the midline closure.