Arch Plast Surg.  2019 Sep;46(5):455-461. 10.5999/aps.2019.00031.

A dual padding method for ischial pressure sore reconstruction with an inferior gluteal artery perforator fasciocutaneous flap and a split inferior gluteus maximus muscle flap

• Ku I
• Lee GK
• Yoon S
• Jeong E

• KMID: 2464622
• DOI: http://doi.org/10.5999/aps.2019.00031

Abstract

BACKGROUND
Various surgical management methods have been proposed for ischial sore reconstruction, yet it has the highest recurrence rate of all pressure ulcer types. A novel approach combining the advantages of a perforator-based fasciocutaneous flap and a muscle flap is expected to resolve the disadvantages of previously introduced surgical methods.
METHODS
Fifteen patients with ischial pressure ulcers with chronic osteomyelitis or bursitis, who underwent reconstructive procedures with an inferior gluteal artery perforator (IGAP) fasciocutaneous flap and a split inferior gluteus maximus muscle flap from January 2011 to June 2016, were analyzed retrospectively. The split muscle flap was rotated to obliterate the deep ischial defect, managing the osteomyelitis or bursitis, and the IGAP fasciocutaneous flap was rotated or advanced to cover the superficial layer. The patients' age, sex, presence of bursitis or osteomyelitis, surgical details, complications, follow-up period, and ischial sore recurrence were reviewed.
RESULTS
All ischial pressure ulcers were successfully reconstructed without any flap loss. The mean duration of follow-up was 12.9 months (range, 3-35 months). Of 15 patients, one had a recurrent ulcer 10 months postoperatively, which was repaired by re-advancing the previously elevated fasciocutaneous flap.
CONCLUSIONS
The dual-flap procedure with an IGAP fasciocutaneous flap and split inferior gluteus maximus muscle flap for ischial pressure ulcer reconstruction is a useful method that combines the useful characteristics of perforator and muscle flaps, providing thick dual padding with sufficient vascularization while minimizing donor morbidity and vascular pedicle injury.

Keyword

Pressure ulcer; Surgical flaps; Osteomyelitis; Bursitis; Ischium

MeSH Terms

Arteries*
Bursitis
Follow-Up Studies
Humans
Ischium
Methods*
Osteomyelitis
Pressure Ulcer*
Recurrence
Retrospective Studies
Surgical Flaps
Tissue Donors
Ulcer