Methods: From 1995 to 1997, the authors used in 12 consecutive paraplegic patients, who had a grade III or IV decubitus ulcer in the ischial area only, two different and independent flaps coupled together in a 'criss-cross' musculocutaneous flap: a split-muscle gluteus maximus flap and a rhomboid fasciocutaneous local flap. The average follow-up period was 3 years and 9 months. Details of the operative procedure are presented to prove that this criss-cross closure of the ischial pressure sore beneficial for patients with spinal cord injury. Results: All flaps survived; recurrence of the decubitus ulcer occurred in one patient (8%). Pressuresore-free survival after surgery was 20 months in the patient with recurrence and an average of 26 months in patients without recurrence. Conclusion:The results obtained confirm this procedure to be safe and useful. We believe this technique to be a valuable alternative for the reconstruction of primary or recurrent ischial pressure ulcers.

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Background:Dealing with circular lesions turns out to be a difficult task. Several techniques are aimed at working out the issue, and there are two main goals to achieve: less distortion of the adjacent tissue and sparing as much healthy tissue as possible.Methods:Six patients have been selected in a period of 6 months, the skin lesions or reoperations entailed a residual round gap up to 5 cm as a diameter. The anatomical distribution is representative of the usual experience seen in the clinical setting. The technique introduced is based on the rotation of two opposing triangular flaps facing each other from the circular skin gap. The triangular landmarks of the flaps prevent both the pinch cushioning of the margins, the resection of wedge healthy tissue needed to regularize the surface and a longer scar.Results:The six patients’ follow-up has been technically uneventful and subjectively satisfying.Conclusion:Double opposing triangular flaps are proposed as a reliable method to deal with circular skin lesions up to 5 cm of diameter.