V‐y Advancement Hamstring Myocutaneous Island Flap Repair of Ischial Pressure Ulcers

Abstract

Thirty‐seven ischial pressure ulcers were repaired in 27 patients (eight quadriplegic, 19 paraplegic) between 1988–1993 using the V‐Y advancement hamstring myocutaneous island flap. Twenty‐one ulcers (57%) arose de now and 16 were recurrent, with five patients having bilateral ulcers. The average duration of the ulcer was 5 months (range 1–30). All ulcers extended through the deep fascia (clinical grade IV), with the average diameter being 4.7 cm (range 2–10). There were four major flap complications (11%). All but one of the ulcers healed at discharge (97%). Mean follow up was 20 months (range 5–54) in 21 patients (78%), with six patients being lost to follow up. Seven of the 21 (33%) patients developed recurrent ulcers, with four of these having flap re‐advancement with successful healing, and one patient having two re‐advancements. Overall, 18 of the 21 (86%) patients with follow up had healed ulcers at time of follow up. The V‐Y advancement hamstring myocutaneous island flap is versatile, reliable, easy to perform, has few complications, and can be re‐advanced in the event of recurrence.

Outcome analyses of a multimodal treatment approach for deep pressure ulcers in spinal cord injuries: a retrospective cohort study

“…Prior to the introduction of plastic surgical lap-flaps in the 1980s, operative procedures were associated with a high number of complication rates and failed closure [14,15]. The current standards for the plastic surgical treatment of grades III and IV PUs in the regions of the sacrum [16,17], the ischium [18,19], and the trochanter major [20,21] are defined by the use of local flaps [1,2].…”

The use of a combined profunda femoris perforator-based fasciocutaneous flap and gracilis muscle flap in the treatment of ischial pressure wounds in patients with limited mobility

“…This workhorse flap has the advantage of providing large volume tissue bulk and well-vascularised muscle, with the robustness of a skin paddle that provides cushioning and stability against shear and moisture. Multiple variations of the hamstring advancement flap have been proposed throughout the years yet all rely on the dissection and sacrifice of the hamstring muscles and their consequential loss of function [3,[11][12][13][14].…”

Variante del colgajo de rotación tipo Hamstring para reconstrucción de úlcera isquiática

“…20 Se destaca la viabilidad del colgajo Hamstring para la reconstrucción de la región isquiática por su bajo número de complicaciones y su menor riesgo de recidivas que otro tipo de colgajos. [21][22][23] El uso de este tipo de colgajos está contraindicado en pacientes ambulatorios que no sean parapléjicos por la pérdida de la función muscular, prefiriéndose en estos casos el uso de colgajos fasciocutáneos o de perforantes. 24…”