{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T16:46:14Z","timestamp":1781541974871,"version":"3.54.5"},"reference-count":21,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2020,12,12]],"date-time":"2020-12-12T00:00:00Z","timestamp":1607731200000},"content-version":"vor","delay-in-days":346,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81772098"],"award-info":[{"award-number":["81772098"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Multi-Disciplinary Team Research Program of the Ninth People\u2019s Hospital"},{"name":"Shanghai Jiao Tong University School of Medicine"},{"name":"Clinical Research Program of the Ninth People\u2019s Hospital"},{"name":"Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019. A description of our management, operative protocol, outcome and complications is outlined. Seven paraplegic patients (6 male, 1 female; average age 53.1\u00a0years) with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery. The average size of the pressure ulcers was 7\u2009\u00d7\u20095\u00a0cm (range 6.2\u2009\u00d7\u20094.5\u00a0cm to 11\u2009\u00d7\u200910\u00a0cm). All 7 flaps survived. The patients were followed up for 12 months without significant complications, such as flap necrosis or recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap. The superior cluneal nerve can be included in the design. The technique is simple and reliable. It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/burnst\/tkaa012","type":"journal-article","created":{"date-parts":[[2020,2,18]],"date-time":"2020-02-18T20:12:58Z","timestamp":1582056778000},"source":"Crossref","is-referenced-by-count":6,"title":["The modified bilobed flap for reconstructing sacral decubitus ulcers"],"prefix":"10.1093","volume":"8","author":[{"given":"Xiangong","family":"Jiao","sequence":"first","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunxiao","family":"Cui","sequence":"additional","affiliation":[{"name":"ENT Institute, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200011, China"},{"name":"Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200011, China"},{"name":"NHC Key Laboratory of Hearing Medicine, Fudan University, 83 Fenyang Road, Shanghai 200011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally Kiu-Huen","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Austin Hospital, 145 Studley Road, Melbourne 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhangjia","family":"Jiang","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chihui","family":"Tu","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiemin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiandong","family":"Lu","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianwen","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Luo","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,12]]},"reference":[{"key":"2020121204433257300_ref1","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/S0003-9993(98)90175-7","article-title":"Magnetic resonance imaging of nonhealing pressure ulcers and 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techniques of flap surgery to improve the success rate for pressure ulcer healing in patients with spinal cord injury","volume":"10","author":"Singh","year":"2013","journal-title":"Int Wound J."},{"key":"2020121204433257300_ref6","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/SAP.0000000000000706","article-title":"The modified Girdlestone procedure with muscle flap for management of pressure ulcers and heterotopic ossification of the hip region in spinal injury patients: a 15-year review with long-term follow-up","volume":"77","author":"Rubayi","year":"2016","journal-title":"Ann Plast Surg."},{"key":"2020121204433257300_ref7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.25270\/owm.2018.2.4548","article-title":"Reconstruction of a sacral pressure ulcer with an inferior gluteal artery perforator flap after failed reconstruction using bilateral V-Y advancement flaps","volume":"64","author":"Wang","year":"2018","journal-title":"Ostomy Wound Manage."},{"key":"2020121204433257300_ref8","first-page":"34","article-title":"Inferior gluteal artery perforator flap for sacral pressure ulcer reconstruction: a retrospective case study of 11 patients","volume":"62","author":"Lin","year":"2016","journal-title":"Ostomy Wound Manage."},{"key":"2020121204433257300_ref9","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/micr.30380","article-title":"A propeller SGAP flap raised from a previous gluteus maximus myocutaneous flap to reconstruct a recurrent type IV sacral pressure ulcer","volume":"38","author":"Saeed","year":"2018","journal-title":"Microsurgery."},{"key":"2020121204433257300_ref10","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s12879-018-3076-y","article-title":"Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy","volume":"18","author":"Andrianasolo","year":"2018","journal-title":"BMC Infect Dis."},{"key":"2020121204433257300_ref11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/PRS.0b013e3181904b24","article-title":"Three-dimensional angiography of the superior gluteal artery and lumbar artery perforator flap","volume":"123","author":"Liu","year":"2009","journal-title":"Plast Reconstr Surg."},{"key":"2020121204433257300_ref12","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s00266-009-9336-x","article-title":"The bilobed flap for reconstruction of distal nasal defect in Asians","volume":"33","author":"Xue","year":"2009","journal-title":"Aesthetic Plast Surg."},{"key":"2020121204433257300_ref13","article-title":"Wound, pressure ulcer and burn guidelines - 2: guidelines for the diagnosis and treatment of pressure ulcers, second edition","author":"Fujiwara","year":"2018","journal-title":"J Dermatol."},{"key":"2020121204433257300_ref14"},{"key":"2020121204433257300_ref15","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/00006534-195306000-00002","article-title":"The bi-lobed flap","volume":"11","author":"Zimany","year":"1953","journal-title":"Plast Reconstr Surg (1946)."},{"key":"2020121204433257300_ref16","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0007-1226(81)80094-X","article-title":"A critical assessment of the bilobed flap","volume":"34","author":"McGregor","year":"1981","journal-title":"Br J Plast Surg."},{"key":"2020121204433257300_ref17","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1001\/archderm.1989.01670190091012","article-title":"The bilobed flap for nasal reconstruction","volume":"125","author":"Zitelli","year":"1989","journal-title":"Arch Dermatol."},{"key":"2020121204433257300_ref18","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.bjps.2012.08.047","article-title":"Reconstruction of the 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