Abstract
BackgroundFlap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores.MethodsIGAP and GT flaps were dissected in 21 fresh human cadavers to allow comparison of anatomical features. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers.ResultsThe IGAP flap was found to be wider and thicker than the gluteal thigh, but presented a shorter pedicle. All flaps healed uneventfully. Recurrent ulcers were treated successfully with both flaps.ConclusionsBoth flaps are suitable for coverage ischiatic and perineal sores. Due to its anatomical features, the IGAP flap should be considered the first choice of treatment for ischiatic ulcers. The gluteal thigh flap should be used in the recurrent sores.Level of Evidence: Level IV, therapeutic study.
Highlights
Treatment of pressure sores (PS) is a challenge for plastic surgeons due to the tendency for recurrence [1]
Inferior gluteal artery perforator flap The anatomical landmarks for the inferior gluteal artery perforator (IGAP) flap are the ischial tuberosity medially, the greater trochanter laterally, and the inferior gluteal crease inferiorly
Clinical study Sixty patients with ischiatic or perineal pressure sores were included in the study
Summary
Treatment of pressure sores (PS) is a challenge for plastic surgeons due to the tendency for recurrence [1]. Conservative treatment increases the possibility for early recurrence as healing by secondary intention usually results in unstable scars [2]. In these cases, both myocutaneous and fasciocutaneous flaps have been used successfully. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers
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