Fig. 1

Second salvage surgery for recurrent pelvic sepsis in the first patient. The perineal fistula a was excised and sacrectomy at the level of S5 performed (b). Sacrectomy was extended with transection below S3 for optimal debridement (c). The gluteal V–Y advancement flap was created and the medial part deepithelialized (d), with layered closure (e)