Ischial Pressure Sores Research Articles

Fournier’s Gangrene Arising from Chronic Ischial Pressure Sore in a Paraplegic Patient: A Case Report

Fournier’s gangrene (FG) is a rare but life-threatening bacterial infection affecting the genital and perianal areas, often associated with high morbidity and mortality rates. Although pressure sores, injuries caused by prolonged pressure on the skin, are considered a risk factor for FG, they are rarely the direct cause of the condition. This case report presents a 65-year-old male with paraplegia and a chronic ischial pressure sore who presented with FG. The patient was treated with prompt surgical debridement and antibiotic therapy, followed by wound reconstruction using a local advancement flap. This enabled a successful outcome, with no further wound issues observed for 6 months. Early diagnosis, imaging modalities, prompt surgical intervention, and appropriate antibiotic therapy are essential for the successful management of FG. This case emphasizes the importance of recognizing the possibility of FG arising from pressure sores and highlights the critical role of early surgical intervention.

Utility of Sensate Pedicled Medial Thigh Perforator Flaps in Treating Recurrent Ischial Ulcers in Individuals with Cauda Equina Lesions and Spinal Dysraphism – A Retrospective Analysis

Abstract Background: Ischial pressure ulcers pose a significant challenge due to their high recurrence rates. It is imperative to provide or establish a reliable, well-vascularized soft-tissue cover over the ischial area to prevent recurrences. The objective of the study was to study the utility and complication rates associated with pedicled medial thigh perforator (P-MTP) sensate flap procedures in managing recurrent ischial ulcers and perineal lesions. Methods: A retrospective cohort study was conducted at Christian Medical College, Vellore, a tertiary care center in South India. This study involved 30 patients with ischial pressure sores. Of these, 13 patients underwent P-MTP flaps, while 17 underwent alternative surgeries for ulcer closure (January 2014–June 2020). Results: Among 13 patients who underwent P-MTP sensate flaps, 1 major complication (full-thickness flap necrosis) necessitated flap revision, while 6 minor complications occurred in the postoperative period. Three patients (23.08%) reported late recurrence of ulcers at the same postoperative site. In contrast, among the 17 patients who underwent the other (alternative) methods of surgical closure, 3 patients had wound dehiscence in the postoperative period. Four patients reported recurrence of ulcer at the postoperative site within 6 months and another four after 6 months of surgical closure. The surgical outcomes in sensate flap surgeries (P-MTP flaps) were comparable to other approaches for surgical closure. Sensation in the P-MTP flap transposed over the ischial region remained intact in all 13 patients at 6-month follow-up. Conclusion: The P-MTP sensate flap is a feasible and reliable treatment strategy for regional soft-tissue reconstruction in ischial and perineal lesions with postoperative complications comparable to other surgical methods for ischial ulcer closure. The sensate flap surgeries offer the additional benefit of maintaining intact sensation over the pressure injury vulnerable ischial region.

Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series.

Most paraplegic patients with complicated trochanter sores or ischial sores present with lower limb muscle atrophy. Therefore, in patients who have undergone Girdlestone arthroplasty, filling the dead space and replacing the volume defect through an appropriate surgical technique is extremely challenging. This study presents a case series of vastus lateralis and vastus intermedius myocutaneous flap reconstruction after extended proximal femoral osteotomy in paraplegic patients. The aim of study is to investigate (i) whether sufficient volume replacement was achieved, (ii) whether muscle volume was maintained during long-term follow-up, and (iii) the presence of donor site morbidity. A retrospective review was conducted with eight patients who underwent this method from March 2017 to December 2021. A total of nine flaps was elevated, and the defect was successfully reconstructed without dead space. Computed tomography was performed to identify the changes in thickness and volume of the muscle portion. The Wilcoxon signed-rank test was performed to assess the significance of the differences in muscle thickness between pre- and post-measurements. After surgery, all patients healed within 1 month; three patients experienced minor complications. The average follow-up period was 14.5 months, during which only one patient with an ischial pressure ulcer developed wound disruption and recurrence. The average thickness of the rotated muscle was 51.95 mm at 2 to 4 weeks postoperatively and 53.07 mm at 6 months postoperatively (𝑝 = 0.071). All nine cases healed well without major complications. When comparing the volume of the rotated muscle on radiological examinations before and after surgery, no significant differences were observed. Our modified Girdlestone resection technique provides a simple and reliable method for reconstructing complex trochanteric or ischial sores in paraplegic patients. It ensures anatomical consistency, ample volume, and structural stability by leaving the rectus femoris (RF) in place. Careful tension management is required when using this flap in the ischial area.

Novel Application of Umbilical Cord Flowable Tissue Allografts in Sacral Decubitus Ulcers: A Case Study

Each year, thousands of patients suffer from sacral decubitus ulcers, also known as pressure ulcers or sores. The current standard of care for sacral decubitus ulcer treatment is expensive and suboptimal, ranging in cost from a 15-dollar tube of Neosporin Ointment to 240,000 dollars for a skin flap surgery. Grade II pressure sores inevitably progress to stage III and IV if not addressed aggressively and early. Late-stage pressure sores present a unique challenge to physicians, particularly when they are deep, tunneling, and have tendon or bone involvement, as is the case for the two patients in this case study. The first patient in this study (referred to as patient 1) was afflicted with a mid-sacral pressure sore with exposed tendon, bone, and tunneling of ten years duration. The second patient in this study (referred to as patient 2) suffered from an ischial pressure sore with exposed tendon, bone, and tunneling for 30 months duration. Both patients exhausted conservative measures, including wound vac placement, oral and IV antibiotic treatment, multiple episodes of sharp debridement, wet-to-dry dressings, silver sulfadiazine dressings, and dehydrated amniotic membrane allograft placements. After failing conservative management, both patients received several applications of Wharton’s Jelly, a Mesenchymal Connective Tissue allograft (MCT), to accelerate wound closure. Conservative management, including sharp debridement, oral antibiotics, and electrical stimulation, was used in conjunction with the WJ allograft applications. At the time of consultation with Dr. Michael Lavor, both patients had Sacral Decubitus Ulcers (SDU) classified as Stage IV with tissue loss and involvement of bone or tendon, according to the National Pressure Ulcer Advisory Panel (NPUAP). After eight months of standardized wound care treatment combined with six Wharton’s Jelly allograft applications, both patients had wounds showing over 90% contraction in depth, tunneling, and diameter. This case study demonstrates a precedent for applying Wharton’s Jelly allografts in late-stage sacral decubitus ulcers with associated tunneling in combination with standard of care. Future research efforts with Wharton’s Jelly allografts applied to recalcitrant wounds may be directed at the frequency and combination of procedural techniques that best promote granulation tissue formation and volumetric contracture of deep wounds by secondary intention.

Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area

Antibiotic treatment of native osteomyelitis caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a challenge. Limited epidemiological and outcome data are available. This retrospective cohort study included osteomyelitis patients with ESBL-PE infections treated in a reference centre for bone and joint infections (BJIs) between 2011-2019. Twenty-nine patients with native BJI (mean age, 44.4 ± 15.7 years) were analysed. Fifteen cases were paraplegic patients with ischial pressure sores breaching the hip capsule. Other cases included eight other hip infections, four tibial infections and two foot infections. Infections were mostly polymicrobial (n=23; 79.3%), including Staphylococcus aureus (n=13; 8 methicillin-resistant). Klebsiella pneumoniae (n=13) was the most frequent ESBL-producing species identified, followed by Escherichia coli (n=10), including 3 E. coli/K. pneumoniae co-infections, and Enterobacter spp. (n=9). ESBL-PE were rarely susceptible to fluoroquinolones (n=4; 13.8%). Most therapies were based on carbapenems (n=22) and combination therapies (n=19). The median duration of treatment was 41 (5-60) days. Primary control of the infection was achieved in 62.1% (18/29) of cases and up to 86.2% after second look surgeries, after a median follow-up of 6 (1-36) months. Infection with ESBL-producing K. pneumoniae was associated with failure (P=0.001), whereas age, infection location, prior colonisation and antimicrobial therapy were not found to be predictors of outcome. ESBL-PE native BJIs are often polymicrobial and fluoroquinolone-resistant infections caused by K. pneumoniae, highlighting the need for expert centres with pluridisciplinary meetings with experienced surgeons.

Successful reconstruction of ischial pressure sores with inferior gluteal artery descending branch perforator flap.

Ischial pressure sores often recur, the surgical choice often troubled the surgeon, because surgery repair should consider future reconstructive procedures. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores by using an inferior gluteal artery of the descending branch perforator flap. A study involving patients suffering from ischial pressure sores was performed from March 2016 to August 2020. Patients with large defects, for which direct closure was not possible, underwent reconstructive surgery using an inferior gluteal artery descending branch perforator flap. Collected data included age, diabetes, wound culture, size of the wound, whether or not negative pressure therapy was received, operative time, intraoperative blood loss, and postoperative complications. Patients were followed up through outpatient visits or by telephone. Five patients with ischial pressure sores (four primary and one recurrent) underwent reconstructive surgery with inferior gluteal artery descending branch perforator flap. One patient received colostomy and wound negative pressure therapy before lesion reconstruction. All patients successfully recovered without postoperative complications. The follow-up period ranged from 4 to 31 months. No wound disruption or recurrence was recorded. Inferior gluteal artery descending branch perforator flap treatment of ischial pressure sores is a simple and feasible method for preserving the inferior gluteal artery's main vascular perforators and could be used as a future surgical option.

Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores—A New Design

Background “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator. Aim and Methods After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same. Results Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group ( p < 0.045), and in only 3 patients of the control group. Conclusions This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.

Hatchet Thigh Flap with Hemi-gluteus Flap for Recurrent Ischial Sore Reconstruction

Background: Ischial pressure sores are the most challenging sores to treat because of associated bursa and high rate of recurrence. Reconstruction flaps originating in the thigh have a disadvantage as movement may increase shear forces, and tension during closure may lead to wound dehiscence. To circumvent these problems, we hereby present a hatchet thigh flap with good mobility, which can be used for recurrent cases as well.Methods: All patients treated at our hospital in the last 5 years for ischial pressure sores were included in the study. The flap is elevated in the subfascial plane from lateral to medial until the medial circumflex artery perforators are revealed. In recurrent cases the lower half of the gluteus maximus muscle is used to fill in the cavity while the flap from the previous surgery is re-advanced.Results: Sixteen patients (11 males and five females) were in the study. The median age of the patient was 54 years (range, 25–82 years). All the flaps survived fully. Two patients had recurrence at three sites, which were successfully reconstructed by advancing the same flap and hemi-gluteus muscle. An average of 6 months follow-up after surgery for recurrence showed stable reconstruction.Conclusion: The hatchet thigh flap is easy to dissect and reliable for ischial pressure sores. It can be used effectively in recurrent cases when combined with hemi-gluteus flaps.

Rotation advancement V-Y posterior thigh flap combined with a biceps femoris muscle flap for reconstruction of a recurrent ischial pressure sore in pediatric patients

Ischial pressure sores are mostly seen in wheelchair-bound pediatric patients, who are affected by a myelomeningocele, as a result of constant shearing force over the ischial region. The ischial sores are the most difficult to treat with high recurrence rates. Although there are various reconstructive modalities that are described for coverage of ischial pressure sores, there is still a long-term debate on an optimal method of reconstruction. Between April 2017 and June 2019, a total of 6 patients who were affected with a myelomeningocele anomalis were operated on for a total of 7 recurrent grade IV ischial ulcers. Data collection was done through analysis of medical records, which included the patients’ demography, operative details, and postoperative complications. A routine preoperative regimen including correction of the nutrition status and anemia should be ensured. We dissected a biceps femoris muscle turnover flap that obliterated the wound cavity and simultaneously applied a V-Y rotation advancement posterior thigh fasciocutaneous flap for coverage of ischial pressure sore surface. All flaps survived without early complications except for one case (14.2%) where a minor wound dehiscence had occurred and managed by secondary stitches. Among all 7 cases, only one (14.2%) had a recurrence 9 months after surgery, which required further debridement and advancement of the same flap. The mean follow-up period was 12.3 months (range, 4–24 months). Although there is still no ideal flap for closure of ischial pressure sores, the rotation advancement V-Y posterior thigh fasciocutaneous flap combined with a biceps femoris muscle turnover flap is considered a reliable reconstructive technique in pediatric patients. The present technique integrates the benefits of well-vascularized muscle tissue with a durable skin coverage that can be reused in cases of recurrence. Level of evidence: Level V, therapeutic study.

Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores

Ischial sores have higher risks of recurrence and considered the most difficult to treat. There are mainly 2 groups of techniques used in ischial pressure sore reconstruction which are as follows: (1) fasciocutaneous and/or myocutaneous flaps (Fc/Mc) and (2) perforator flaps. The aim of this study is to determine the advantages of perforator flaps over Fc and/or Mc flaps in reconstruction of ischial pressure ulcers. All articles published before April 2018 were investigated and searched for eligibility using the databases PubMed and Google Scholar. Eligible studies were determined according to inclusion and exclusion criteria. Recurrence rates, complication rates, and time of recurrences were assessed. A total of 15 studies with 279 patients and 305 flaps were identified and included in the final analysis. The overall recurrence rate of flaps was 6.31 (95% CI, 5.86 to 6.78; p 0.05), complication rates (p > 0.05), and time of recurrences (p > 0.05). Perforator flaps mandate thorough pre-operative preparations, meticulous dissections, and long surgery times. There seem no advantage in applying perforator flaps in ischial pressure sore reconstructions in terms of complications and recurrences. Surgeons may prefer to perform straightforward procedures, such as myocutaneous flaps. Level of evidence: Level IV, risk/prognostic, therapeutic study.

Distal partial gluteus maximus musculocutaneous V-Y flap: a simplified technique for reconstruction of ischial pressure sores

Ischial pressure sores are mostly seen in wheelchair-bound patients and they have a high risk of recurrence due to a multitude of reasons compared with sacral and trochanteric ulcers. Various treatment modalities have been presented but high recurrence rates maintain its importance. Between 2009 and 2016, a total of 14 patients with spinal cord injuries were operated on for a total of 17 Shea stage IV ischial ulcers with the described technique. Demographic variables were recorded. Postoperative outcomes were categorized as early and late complications. A partial distal portion of gluteus maximus muscle (not the whole) was dissected and freed from the femoral insertion. The muscle was used as a carrier for the triangular flap lying above. The muscle was transposed medially and the triangular flap was advanced in a V-Y fashion to cover the defect. The follow-up periods ranged between 15 and 61 months. Among all the 14 patients, only one (7.1%) had a recurrence after 1 year postoperatively which needed an additional debridement and advancement of the previous flap. This patient had a non-recurrent period of 16 months after the second operative procedure. Wound dehiscence, as an early complication, was seen in one patient which healed secondarily. The distal partial gluteus maximus musculocutaneous V-Y flap is a simple and new approach with low complication rates for reconstruction of ischial pressure sores. Although there is still not an ideal flap for this challenge, the present technique could be a reliable option for the reconstructive armamentarium.Level of evidence: Level IV, therapeutic study.

Reconstruction of Ischial Pressure Sores with Adjacent Muscle Primary Closure and Freestyle Perforator-Based Fasciocutaneous Flaps

Reconstruction of Ischial Pressure Sores with Adjacent Muscle Primary Closure and Freestyle Perforator-Based Fasciocutaneous Flaps

Spinal cord injured women's treatment of breast carcinoma: alert to complications.

Women with spinal cord injury (SCI) and who develop breast cancer are a vulnerable and potentially overlooked population. They experience risk factors owing to decreased mobility and are at risk for unique complications from their oncologic treatment. A 54-year-old woman who suffered a T6 AIS A traumatic SCI in 1981, who was diagnosed 32 years later with estrogen receptor and progesterone receptor positive and human epidermal growth factor receptor 2-negative invasive ductal carcinoma. During the course of her chemotherapy, she experienced several complications, including reflexive diaphoresis, urinary tract infection, leukopenia, anemia, dehydration, and weakness. These contributed to the development of a stage 4 ischial pressure sore, which required complex treatment. There is a paucity of literature examining the complications of chemotherapy that may be unique to those with SCI. Physiatrists will be seeing more women undergoing oncologic care, as this population of patients ages. A multidisciplinary approach that takes into account the pathophysiologic changes associated with SCI is crucial to understand and prevent complications that could affect their outcomes and contribute to increased cost in a value-based health-care system.

A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure.

Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.

The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study

The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery). Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers. The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.

Infragluteal fasciocutaneous flap for management of recurrent ischial pressure sore.

Objective:The objective of the study was to determine the feasibility of infragluteal fasciocutaneous flap in recurrent ischial pressure sore.Materials and Methods:In our study, from 2015 to 2017, nine patients suffering from recurrent ischial sore with scars of previous surgery were managed with infragluteal fasciocutaneous flap. Wound bed was prepared by surgical debridement and negative pressure wound therapy in each case. In two cases, gracilis muscle flap was used as adjuvant to fill up the residual cavity. Donor area of flap was primarily closed.Results:Infragluteal fasciocutaneous flap was used in all nine cases. Superficial distal congestion was present in two cases. Haematoma (1) and infection (1) at flap donor site occurred. Recurrence of ulcer was observed in two cases which were managed by bursectomy and advancement of the bridge segment of the original infragluteal fasciocutaneous flap. All flaps survived without any major complication.Discussion:Ischial pressure sores have a tendency of recurrence after conservative or flap surgery. Scars due to previous surgeries adjacent to the pressure sore preclude the use of local skin or muscle flap. Infragluteal fasciocutaneous flap is a thick reliable fasciocutaneous flap that can be used for resurfacing recurrent ischial pressure sore. This flap has an axial pattern blood supply along with rich subfascial and fascial plexus supplied by various perforators.Conclusion:Infragluteal fasciocutaneous flap is reliable option for managing recurrent ischial sore as it transposes well-vascularised thick fasciocutaneous flap from adjacent posterior thigh and its bridge segment can be further used in case of recurrence.

Role of Plastic Surgeon in the Management of Pressure Ulcers during Rehabilitation of Patients with Traumatic Spinal Cord Injury: A Tertiary Hospital Experience

Background: Pressure ulcers and their management represent one of the most challenging situations following traumatic spinal cord injury (SCI). It requires frequent hospitalizations and hence aggravates the physical, psychological and socioeconomic burden of patients and their caregivers. Early surgical intervention will help in reducing the morbidity as well as improve the quality of life of these patients. In this study,we present a retrospective review of reconstructive surgeries for pressure sores highlighting the role of the plastic surgeon in the rehabilitation of traumatic SCI. Methods: A three-year retrospective review (January 2014–December 2017) of 25 traumatic SCI patients who underwent reconstructive surgeries for pressure ulcers in the Department of Plastic Surgery in a Tertiary Care Government Hospital in South India was done.Variables like demographic and clinical details, reconstructive procedures done, postoperative complications, duration of hospital stay and relation of wound complication with serum albumin were statistically analyzed and interpreted using statistical package for social sciences (SPSS) software. Results: Twenty-five male patients with age between 22 and 69 years (mean age = 49.4+/-12.24)were analyzed. 88% of the patients (n = 22) had paraplegia, and 12% had quadriplegia. 12% of patients had a cervical spinal injury, while 88% had a thoracolumbar injury. Mean duration of hospital stay was 36.5 days.Of the 25 patients, 68% (n = 17) had pressure sores at multiple sites while the rest had a single pressure sore. Of the total 49 pressure sores, 30 were ischial, 11 sacral, 7 trochanteric and one perineal pressure sore.Forty-five pressure sores were of grade II/IV and was managed with various flap reconstructions. One sacral pressure sore and one ischial pressure sore (grade II) underwent excision and primary closure. Split skin grafting was done for 2 sacral pressure sores. Postoperative wound complications were analyzed and there was a significant relation between hypoalbuminemia and major wound complications (Fischer exact p = <0.0001) Conclusion: Plastic surgeons have an important role to play in the rehabilitation phase of traumatic spinal cord injury patients with pressure sores. Early reconstructive surgeries for pressure sores will prevent the development of complications and provide better quality of life (QOL) for these patients.

Lambeau fasciocutané sous fessier fiabilisé par une perforante de l’artère fémorale profonde en reconstruction d’escarre ischiatique

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

The posterior thigh flap for defect coverage of ischial pressure sores - a critical single-centre analysis.

The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight-bearing area in wheelchair-mobilised patients and is prone to high mobility. The purpose of our study was to report our long-time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap. A retrospective analysis of all primary pressure sores grade III-IV in the ischial area, which were covered with a medially based posterior thigh flap between January 2008 and December 2014, at our department was conducted. A total of 28 patients underwent defect coverage of an ischial pressure sore with the aforementioned flap. The subgroup with complications showed a statistically significant longer hospital stay. A statistically significant correlation between age and the coincidence of comorbidities could be seen. Older patients showed significantly higher grades of pressure sores. The medially based posterior thigh flap is a safe and reliable flap design. Complication rates are comparable to other flaps. Nevertheless, in case of complications, a significantly longer duration of hospitalisation has to be taken into account.

Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

&lt;p&gt;Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent &lt;em&gt;reoperation&lt;/em&gt; and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.&lt;/p&gt;