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

Abstract

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.

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

“…This study confirmed that the chimeric flap could effectively cover the exposed prosthesis and obliterate the dead space. Arikrishnan et al 13 reconstructed ischial pressure sores using a chimeric flap based on an inferior gluteal artery perforator, providing evidence that the gluteal chimeric perforator flap can obliterate subfascial voids. However, no study has reported the use of CPPF based on SGAP to reconstruct complex sacrococcygeal defects.…”

“…Each part of the flap can have relatively independent anatomical components, ranging from the skin to the muscle, providing the possibility of repairing defects at different locations. In a case series involving 21 patients, Arikrishnan et al 13 confirmed the feasibility of pedicled chimeric perforator flaps in the reconstruction of ischial pressure sores involving dead space.…”