Contour-Preserving Reconstruction for Extensive Gluteal Burn Using a Muscle-Sparing Latissimus Dorsi Free Flap: A Case Report

Reconstructing coccygeal defects can be challenging because stable coverage must be achieved while preserving the natural contour of the gluteal region. Successful reconstruction requires not only durable coverage but also adequate restoration of soft-tissue volume and gluteal contour. A 29-year-old woman developed a full-thickness burn with exposed bone in the coccygeal region after prolonged contact with an electric heating pad. Initial treatment with split-thickness skin grafting resulted in partial graft loss and persistent necrosis. To optimize the wound bed, serial debridement and negative-pressure wound therapy were performed. Despite adequate preparation, a 12×12 cm defect with a maximal depth of approximately 2 cm and clinically relevant three-dimensional dead space remained. A muscle-sparing latissimus dorsi (msLD) free flap was used for definitive reconstruction. The limited muscle component was used to obliterate the dead space, while the flap was contoured to restore soft-tissue volume. The postoperative course was uneventful, with stable flap coverage and maintained gluteal contour. This case demonstrates that an msLD free flap can provide durable coverage, dead-space obliteration, and contour restoration in an extensive coccygeal defect.