Systematic Review and Operative Technique of Recalcitrant Pressure Ulcers Using a Fillet Flap Technique

Abstract

Background:The purpose of this article is to describe the indications, operative technique, outcomes, and systematic review of the literature on the reconstruction of patients with end-stage pressure ulcers using a fillet flap technique. In this technique, the femur, tibia, and fibula are removed from the thigh and leg, and the soft tissue is used as a pedicled, or free, myocutaneous flap for reconstruction. Long-term outcomes, salient surgical technique of flap elevation, and design are detailed for patients who had a fillet of leg flap for reconstruction of extensive pressure ulcers.Methods:The indications, surgical technique, and postoperative outcomes of 5 patients who had pedicled fillet flaps are reviewed including patient age, sex, underlying comorbidities, duration of paraplegia, operative technique, and complications. A systematic review of the literature was performed searching PubMed, Cochrane Database, and Medline with the following MeSH terms: pressure ulcer, pressure sore, decubitus ulcer, fillet flap, and fillet flap. Inclusion criteria were use of a fillet technique, article data on the number of reconstructions before fillet flap, complications, and English language.Results:Most of our patients were male 75% (n = 3) with an average age of 47.5 years, had been paralyzed for an average of 16 years, and had few medical comorbidities. Two patients (3 flaps) required hip disarticulation, 1 patient had a bilateral fillet flaps, and 3 patients had resection of tibia/fibula. After following patients for an average of 1.4 years (4 mo to 2 yr), complications were limited to 1 patient who had partial-thickness flap loss at the distal skin flap that healed by secondary intention and 1 patient who had ulcer recurrence because of noncompliance. Four articles met inclusion criteria for systematic review and 3 were excluded.Conclusions:The fillet of leg flap remains a useful and reliable method of reconstructing end-stage pressure ulcers.

A Giant Neurovascular Lower Limb Fillet Flap Can Simultaneously Cover Pelvic and Abdominal Defects

“… 3 More case series followed mainly for pressure ulcer coverage in paraplegic and nonparaplegic patients. 4 , 5 The classical fillet flap emerged from the “spare part” concept, using tissues from amputated or otherwise discarded body parts to replace important functional structures. 1 However, the fillet flap was never described to simultaneously cover both a pelvic and abdominal soft-tissue defect.…”

Extremity free fillet flap for reconstruction of massive oncologic resection—Surgical technique and outcomes

“…The “spare part” concept, which consists of transferring tissues from amputated or otherwise discarded body parts, is a well‐established principle in reconstructive surgery . Ever since Russel et al described a microsurgical procedure using viable tissue spare parts for reconstruction of a traumatic below‐knee amputation, the use of the fillet flap technique has been used for a multitude of elective surgeries, such as oncological and pressure ulcer reconstruction . Reports of free fillet flaps for limb reconstruction are limited .…”

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

“…[ 20 ] Various flaps (generally accompanying Z-plasty and W-plasty), such as myocutaneous, fasciocutaneous, and subcutaneous flaps, and even some peculiar flaps, such as island flaps, perforator flaps, V-Y flaps, and distally based flaps, are applied in plastic surgery. [ 21 , 22 ] Based on a large number of flap operations, clinical experience indicates that the use of GMMs or fasciocutaneous flaps to fill sacrococcygeal tissue defects is effective and can improve appearance. [ 23 ] V-Y flaps are generally used for small tissue defects, such as fingertip defects.…”