Combination of flaps for severe pressure-induced injury

The patient suffered extensive stage four pressure-induced injury to the lower back and sacrum after surgery for spinopelvic dissociation after from a serious fall. Note the presence of hardware in the wound (A). Following thorough debridement, NPWT was used to prepare the wound base (B,C). A large V-to-Y advancement flap from the right side (D,E) and a large superiorly based gluteus maximus rotation flap from the left side (D,F) were used to accomplish closure.