The anatomical basis of a new method for re-innervation of the gluteal region in paraplegics.

The surgical treatment of pressure sores in paraplegic patients currently consists of myocutaneous flaps, direct suture and cover with split thickness skin grafts. These surgical methods of closing defects in pressure bearing areas do not normally provide any sensory function unless the skin flaps have intact sensibility or have been re-innervated in a first stage operation. The aim of the present project is to study the feasibility of re-innervating the gluteal region directly by mobilizing intercostal nerves, extending their reach by nerve grafts and neurotization of the required area without involving other skin areas so achieving: 1) re-innervation of skin to gain protective sensibility in the pressure bearing area, 2) re-innervation of the gluteus maximus muscle to gain voluntary muscle contraction to improve blood flow and diminish ischaemia. So far, 10 cadaver dissections have been performed to define anatomical relationships. Different intercostal nerves were dissected to allow for the various levels of spinal cord lesion among the patients. Through an incision in the midgluteal region, the sensory nerve to the skin covering the ischial tuberosity and the motor nerve to the gluteus maximus were located. The technical possibilities of connecting these nerves to intercostal nerves via sural nerve grafts were demonstrated.