This post is an adaptation and improvement in english [ENG] from my post:Source; plastic surgery for people in need.

In plastic surgery not everything is about implant placement and body aesthetics as many people think, it covers a wider spectrum of reconstructive and curative surgeries that few of us see and that unfortunately society has devalued to make the industrialized body prototype of "perfect" women and men more important. Among these types of reconstructive and curative surgeries, we are faced with a particular case that caught my attention.

To the Skin!

Skin defect in the gluteal area resulting from a chronic eschar that could not heal by conventional means. A photograph is taken very close to the area to see details of injured skin.

It is important at this point to determine that a skin graft is the skin that is completely removed from a site (donor) to the site where it will eventually be placed to cover the defect or injury (recipient). On the other hand, the flap is based on the same principle, but the difference is that it is still attached to the donor site by a vascular pedicle that allows blood to flow through it. It can be a little confusing to understand, but we will see it in the images.

Starting the measurements with the bone points as reference.

Approximate total length of the Skin Flap from the thigh area to the flute area on the same side.

Once the measurements of the flap are made at the donor site, which in this case was the skin of the anterior thigh area, the cutting sites of the scalpel are determined by tracing sterile markers for the operating room.

The site of the lesion is located where the pressure ulcers (those holes in the buttock region) are located and measured as a reference for the skin flap.

The procedure is summarized in two major phases: the first is where the patient on his or her back makes a healthy skin cut of the thigh and the second is where the patient on his or her stomach receives the flap to fill the gluteal area. Notice that the rectangle of healthy skin is not cut off completely, but its root is attached to the site and then the free end is the one that will serve the purpose of covering the lesion.
Dissection of the previously established limits. Note how the base that will provide the blood supply is attached to the skin flap.

Image (Source)

Release of the flap and exposure of the fatty tissue and muscle mass, the surrounding skin is also removed from the "unhealthy" buttock region and cleaned.

Flap rotation procedure.

Once the cut has been made (except for the base), the flap is rotated, where it is possible to see through the images how passing under the skin, the skin of the thigh covers the defective area in the buttocks.

Complete Flap Rotation Procedure

The procedure for releasing healthy or donor skin has to be very careful as it has to be thick enough to cover, but not so thick enough to rejoin the edges that remain after the release. In addition, great care must be taken to preserve the arteries that nourish it and provide vitality to this healthy tissue.

The final result

Anterior rotating flap from thigh to buttock region.

The final size and location is carefully measured and the scalpel is then used to delimit it and finally the plane suture procedure is performed.

It is one of those interventions that we call "major" because of all the challenges it faces, not only from an aesthetic point of view, but also from a functional point of view: that is, to avoid even greater injuries.

It was some time before I saw the patient's relatives again, who were very grateful and satisfied with the surgery. Definitely thanks to the well-developed tactics of the team of plastic surgeons I was able to learn that not everything is aesthetic, but that there are patients who benefit from the achievements of a "plastic" scalpel.