Pedicled chimeric muscle and anterolateral thigh fasciocutaneous flap reconstruction of trochanteric pressure wounds: Presentation of two cases

Abstract

Abstract Trochanteric pressure wounds are a significant cause of morbidity among paraplegic and comorbid patients. Their surgical management requires femoral head ostectomy followed by robust soft tissue coverage both for dead space obliteration and for skin and subcutaneous tissue replacement. Many flap options and their variations have been presented for this purpose. We present a unique methodology utilizing a chimeric pedicled muscle and anterolateral thigh (ALT) flap for reconstruction. First, we present a paraplegic 39-year-old male who underwent a right Girdlestone procedure followed by a pedicled chimeric vastus lateralis and ALT flap for trochanteric pressure wound reconstruction. Secondly, we present a 55-year-old paraplegic male with a similar pathology on the left, who underwent a pedicled chimeric rectus femoris and ALT flap reconstruction. Both surgical courses were uncomplicated and with no wound recurrence. Our cases demonstrate that this modification of previously described reconstructions is a viable option for the reconstruction of trochanteric pressure wounds. The literature abounds with reconstructive options for trochanteric wound reconstruction, but none without limitations. We add another durable and robust coverage modality to the reconstructive surgeon’s armamentarium. The chimeric pedicle muscle and ALT flap surgical reconstruction is a viable technique in management of trochanteric pressure wound reconstruction. • Chimeric flap design provides benefits of both muscle and fasciocutaneous flaps. • Chimeric flap design is a viable technique for trochanteric pressure wounds. • There are many options for paddle selections. • Donor site morbidity is minimal and it creates nominally, if any, more scar burden.