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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, Inhoe (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Lee, Gordon K. (Division of Plastic and Reconstructive Surgery, Stanford University Medical Center) ;
  • Yoon, Saehoon (Department of Plastic Surgery, SMG-SNU Boramae Medical Center) ;
  • Jeong, Euicheol (Department of Plastic Surgery, SMG-SNU Boramae Medical Center)
  • Received : 2018.12.12
  • Accepted : 2019.06.19
  • Published : 2019.09.15

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.

Keywords

References

  1. Hurteau JE, Bostwick J, Nahai F, et al. V-Y advancement of hamstring musculocuataneous flap for coverage of ischial pressure sores. Plast Reconstr Surg 1981;68:539-42. https://doi.org/10.1097/00006534-198110000-00011
  2. Ramirez OM, Orlando JC, Hurwitz DJ. The sliding gluteus maximus myocutaneous flap: its relevance in ambulatory patients. Plast Reconstr Surg 1984;74:68-75. https://doi.org/10.1097/00006534-198407000-00010
  3. Pena MM, Drew GS, Smith SJ, et al. The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores. Plast Reconstr Surg 1992;89:90-5. https://doi.org/10.1097/00006534-199289010-00018
  4. Rubin JA, Whetzel TP, Stevenson TR. The posterior thigh fasciocutaneous flap: vascular anatomy and clinical application. Plast Reconstr Surg 1995;95:1228-39. https://doi.org/10.1097/00006534-199506000-00014
  5. Lindan O, Greenway RM, Piazza JM. Pressure distribution on the surface of the human body. I. Evaluation in lying and sitting positions using a "bed of springs and nails". Arch Phys Med Rehabil 1965;46:378-85.
  6. Resnick NM, Beckett LA, Branch LG, et al. Short-term variability of self report of incontinence in older persons. J Am Geriatr Soc 1994;42:202-7. https://doi.org/10.1111/j.1532-5415.1994.tb04953.x
  7. Chassagne P, Landrin I, Neveu C, et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med 1999;106:185-90. https://doi.org/10.1016/S0002-9343(98)00407-0
  8. Tam EW, Mak AF, Lam WN, et al. Pelvic movement and interface pressure distribution during manual wheelchair propulsion. Arch Phys Med Rehabil 2003;84:1466-72. https://doi.org/10.1016/S0003-9993(03)00269-7
  9. Borgognone A, Anniboletti T, De Vita F, et al. Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a 'criss-cross' way. Spinal Cord 2010;48:770-3. https://doi.org/10.1038/sc.2010.25
  10. Bertheuil N, Aillet S, Heusse JL, et al. Ischial pressure ulcers: long-term outcome of 2 surgical techniques. Ann Plast Surg 2014;73:686-91. https://doi.org/10.1097/SAP.0b013e31828587f0
  11. Kim J, Yang HJ. Reconstruction of ischial pressure sores with adjacent muscle primary closure and freestyle perforator-based fasciocutaneous flaps. J Wound Manag Res 2018; 14:85-90. https://doi.org/10.22467/jwmr.2018.00311
  12. Sharma RK. Split gluteus maximus island flaps for concomitant closure of ischial and sacral pressure sores. Ann Plast Surg 2001;46:52-4. https://doi.org/10.1097/00000637-200101000-00011
  13. Vincent PL, Pinatel B, Viard R, et al. The gluteus maximus inferior split-muscle flap for the cover of ischiatic pressure ulcers: study of 61 cases. Ann Chir Plast Esthet 2016;61: 845-52. https://doi.org/10.1016/j.anplas.2016.08.004
  14. Ramirez OM, Hurwitz DJ, Futrell JW. The expansive gluteus maximus flap. Plast Reconstr Surg 1984;74:757-70. https://doi.org/10.1097/00006534-198412000-00003
  15. Higgins JP, Orlando GS, Blondeel PN. Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg 2002;55:83-5. https://doi.org/10.1054/bjps.2001.3713
  16. Kim YS, Lew DH, Roh TS, et al. Inferior gluteal artery perforator flap: a viable alternative for ischial pressure sores. J Plast Reconstr Aesthet Surg 2009;62:1347-54. https://doi.org/10.1016/j.bjps.2008.03.026
  17. El Omari M, Casoli V, Pinsolle V. Inferior gluteal artery perforator flap: anatomical study for its application in breast reconstruction. Ann Chir Plast Esthet 2011;56:287-97. https://doi.org/10.1016/j.anplas.2011.03.002

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