Treatment of Ischial Pressure Sores with Both Profunda Femoris Artery Perforator Flaps and Muscle Flaps

Abstract

BackgroundReconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores.MethodsWe retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course.ResultsAll flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months.ConclusionsThe combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

The Posteromedial Thigh Flap for Head and Neck Reconstruction

“…Thus, the early clinical applications of this flap were for ischial pressure sore reconstruction. [12][13][14][15] Later, Allen et al reported the first use of the profunda artery perforator flap for breast reconstruction. 16 Initially, the flap harvesting was performed in the prone position, and a supine "frog-leg" position was later adopted to eliminate the need for repositioning.…”

“…12 The clinical application of skin flaps from the posterior medial thigh region was most often used for ischial pressure sore reconstruction. [12][13][14][15] Allen et al reported the profunda artery perforator flap for autologous breast reconstruction when abdominal tissue was not available and, recently, the posterior medial thigh flap has been described as a free flap for breast reconstruction. [16][17][18] To our knowledge, there is a paucity of data describing the clinical application of this flap for head and neck reconstruction.…”

The versatility of profunda femoral artery perforator flap for oncological reconstruction after cancer resection—Clinical cases and review of literature

“…Homma et al described using this flap as a proximally based pedicle flap to treat ischial pressure and used skin paddles ranging from 11 to 23 cm × 5 to 6 cm with favorable results in 10 patients. It was also demonstrated that closure of both the ischial defect and donor site could be achieved simultaneously . This option can be modified using the propeller concept for flap transposition as introduced by Hallock reported in two patients.…”

Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients

“…Fasciocutaneous flaps (e.g. anterolateral thigh perforator flap, gluteal perforator flap, gracilis perforator flap, and profunda femoris perforator flap) have good blood supply, sufficient bulk and allow for muscular function preservation . However, they may become less useful when filling of a wound with significant depth is required.…”