Layered Repair in Extensive Sacral Defects with Bilaminar Gluteal Flaps: Demirdover Flaps.

Background: The reconstruction of extensive sacral defects following the resection of chordomas and malignant tumors poses a significant challenge. Local flaps are often preferred over free flaps due to the challenging vascular anatomy of the region. However, many local flaps lack the necessary volume and vascularity to adequately fill the defect. Methods: Twelve patients with extensive sacral defects who underwent reconstruction with the bilaminar gluteal flap, named the Demirdover flap (DF), were included in the study. The following variables were evaluated: patient demographics, tumor type, defect size, resection and reconstruction details, complications, and follow-up time. The DF is a viable alternative to regional or free flaps for reconstructing extensive sacral defects. Results: All patients were men, and the mean age was 63.2 years. Most of the patients had chordoma (58.3%). The body mass index of all patients was recorded, and they were either normal or overweight. All patients received adjuvant radiotherapy. None of the patients experienced severe complications during the follow-up period. Conclusions: The DF flap is a promising option for reconstructing extensive sacral defects. The DF flap offers adequate volume as a result of the 2-layer design, ensuring sufficient tissue volume to fill the defect. Furthermore, preserving the muscle's neurovascular structures enhances blood supply, and the flap's design minimizes muscle disruption, promoting better function.