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

Legemate, Catherine M.; Kwaak, Monique van der; Gobets, David; Huikeshoven, Menno; Zuijlen, Paul P. M. van

doi:10.1016/j.bjps.2018.01.032

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…23,24 IPSs are the most common type of recurring pressure ulcers. 19,23,24 Surgery is the established best modality for the treatment of most of the pressure ulcers occurring in the chronic myelopathic patients. 25,26 IPSs are difficult to treat due to high recurrence and complication rates up to 40 to 50%, despite successful surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Arikrishnan

Balakrishnan

Janardhanam

2021

Indian J Plast Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Arikrishnan

Balakrishnan

Janardhanam

2021

Indian J Plast Surg

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“…Techniques defined for the repair of ischial pressure ulcers include using phytocutaneous flaps, perforator flaps, and myocutaneous flaps. [15][16][17] Fasciocutaneous rotation flaps were employed most frequently in this study to treat ischial pressure ulcers.…”

Section: Discussionmentioning

confidence: 99%

Management and treatment of pressure ulcers: Clinical experience

Irmak¹

2018

Sisli Etfal

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P ressure ulcers are frequently observed in bedridden patients and can lead to major problems when left untreated. There is a high prevalence in hospitalized patients requiring long-term treatment. [1] They are a major reason for hospitalization in immobile patients, and are often seen in elderly patients with impaired sensory function. This represents a significant cost to the healthcare system, and the mortality rate in this patient group is unnecessarily high. Risk factors for pressure ulcers other than advanced age include neurological defects, malnutrition, chronic disease, and immobility. In spite of the development of preventive health services, more than 90% of patients with a spinal cord injury have been reported to develop pressure ulcers, especially in developing countries. [2] The prevalence among hospitalized patients has been as much as 18.1% in Europe, [3] and in studies performed in our country, the Objectives: Pressure ulcers are a common healthcare problem, particularly among hospitalized patients who need long-term treatment; however, preventive medicine can reduce the prevalence. A multidisciplinary approach is fundamental to providing proper care, and the general health status and cooperation of the patient determine treatment modalities. Simple methods can prevent pressure ulcers and their recurrence. The aim of this study was to share clinical experience and evaluate the approach and treatment modalities used for pressure ulcers. Methods: Fifty-two patients hospitalized with the indication of pressure ulcers were evaluated retrospectively. Age, sex, localization of the decubitus ulcer, treatment method, comorbid diseases, and any postoperative complications were analyzed. Results: Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed. Conclusion: The most important point with regard to pressure ulcers is prevention. Healthcare system expenses can be significantly reduced by preventing the formation of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment are provided in the early period. The role of the plastic surgeon in advanced stages is to perform reconstruction in appropriate cases and to educate patients and their caregivers with the aim of preventing recurrence.

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“…There are multiple types of flaps that can be used in flap surgery for pressure sores, each of which has its unique advantages. Examples include the inferior gluteal artery perforator flap (1), internal pudendal artery perforator flap (2), gluteus maximus island…”

Section: Introductionmentioning

confidence: 99%

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

Li¹,

Lai²,

Zheng³

et al. 2021

Ann Palliat Med

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Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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

Cited by 17 publications

References 16 publications

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

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

Management and treatment of pressure ulcers: Clinical experience

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

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