Recurrent Ischial Sores Research Articles

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.

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.

Management of a Recurrent Ischial Sore Using a 3-Flap Technique.

Management of a Recurrent Ischial Sore Using a 3-Flap Technique.

Versatility of perforator sparing buttock rotation flap in repair of pressure sores

Eleven perforator-sparing gluteal fasciocutaneous rotation flaps were used for coverage of pressure sores in 10 patients with mean age 38.4 years. Nine patients were paraplegic, and one patient was ambulatory. All pressure ulcers were classified as grade 4. The pressure sores were sacral in five patients, unilateral ischial in five patients, and unilateral trochantric in one patient. Seven ulcers were recurrent and four were primary. The flap sizes ranged from 7 × 7 cm to 15 × 13 cm. In a total of 11 flaps, nine flaps included two perforators, one flap included three perforators, and one flap included single perforator. Skin incision is the same as that for the conventional gluteal rotation flap. The flap is elevated subfascially until at least two dominant musculocutaneous perforators of the superior or inferior gluteal arteries are encountered. In the recurrent ischial sores, the inferior part of gluteus maximus was used to fill dead space at the base of the ulcer as a separate muscle flap. Eight of 11 flaps healed uneventfully without complications. Mean follow-up period was 18.6 months (range 37–5 months). The recurrence rate in the same region was 0% during follow-up period. The appearances of pressure sores in other sites occurred in two patients that healed with conservative treatment. There was no major complication such as total flap necrosis. Only minor complications occurred which were treated without surgical intervention. The perforator-sparing gluteal rotation fasciocutaneous flap is a versatile and reliable flap for coverage of all gluteal pressure sores. This is an ideal flap for patients in whom the risk of ulcer recurrence is high as the rerotation is possible in case of recurrence.

The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers

Chronic recurrent ischial sores are an important cause of morbidity in paraplegics and geriatric patients. Compared to sacral and trochanteric ulcers, ischial sores are the most difficult to treat, with a low success rate following conservative therapy and a high recurrence rate after surgical treatment. We report the use of the pedicled anterolateral thigh (pALT) flap for reconstruction of a chronic ischial sore. The free ALT flap has an established role in reconstruction in the head and neck and extremities. However, there are few reports concerning its clinical applications for regional reconstruction. As a pedicled flap, it has been used in the primary reconstruction of the perineum, groin, anterior abdominal wall, thigh and ischium. We present the first reported case of a paraplegic man with a recurrent ischial sore treated successfully with an island pALT flap inset via a lateral subcutaneous approach. We discuss the indications and its role as a simple and reliable secondary reconstructive option in the treatment of recurrent ischial ulcers after first-line loco-regional surgical options have been exhausted.