Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers

Abstract

Introduction Single best perforator-based Pacman flap (SBPBPF) fortifies the advancement and transposition flap biogeometry principles with robust blood supply of perforator flaps to provide cover for the sacral pressure sore of any dimension. This article describes the biogeometry and technique of raising the SBPBPF. Aim To assess the outcomes of reconstruction of stage IV sacral pressure sore using the SBPBPF. Materials and Methods A preliminary cadaver study was done in 24 gluteal specimens in fresh cadavers to determine the anatomical details of perforators of the perisacral region. From 2015 to 2017, 42 myelopathic patients (40 males and 2 females; quadriparetic n = 2 and paraplegic/paraparetic n = 40) underwent SBPBPF reconstruction of stage IV sacral pressure sore. Their documents were analyzed in this retrospective study. All were followed-up for an average period of 12.5 months. Results Cadaver study revealed significant perforators arising from seven different source vessels in the perisacral region. In the clinical study, average size of the paddle harvested was 168 cm2 on a single best perforator. On an average, the size of the single best perforator harvested with the flap was 1.5 mm. None had early failures of flaps. Thirty-nine patients had well-settled flaps at the end of follow-up period except three (7%) who developed late recurrence due to loss of compliance with offloading instructions. Two experienced mild collections (flap complication rate was 4.76%) in the immediate postoperative period that healed uneventfully. The overall complication rate was 11.9%. Conclusion SBPBPF is an excellent addendum to reconstructive tool for stage IV sacral pressure sores.

Comparative Study between Gluteal Artery Perforator Flaps and Local Fasciocutaneous Flaps in Reconstruction of Gluteal Pressure Ulcers

“…In addition, these ulcers represent a difficult challenge for plastic surgeons owing to their high rates of wound complications and recurrences. 10 …”

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

“…Pressure ulcers are a serious problem that affect different sites in the body causing personal, family, health and social problems among high number of patients, especially the paraplegic and tetraplegic ones. Furthermore, they represent a difficult challenge for plastic surgeons because of their high wound complications and recurrences rates [9].…”

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

“…5 ). The biogeometry elicited by Balakrishnan et al 22 was followed. A nondelineating incision was placed ( Fig.…”

“…Therefore the “subfascial void reconstruction” in the stage-four IPSs (according to National Pressure Ulcer Advisory Panel [NPUAP]) goes a long way in the amelioration of these common complications. So, we designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) a Pacman-style fasciocutaneous flap component 22 and (2) the inferior portion of the gluteus maximus muscle, harvested on another independent perforator from the same source. The Pacman-style fasciocutaneous flap component has the advantage of reusability and homogenous high vascularity to reconstruct the suprafascial defect of IPSs.…”

“…The Pacman-style fasciocutaneous flap component has the advantage of reusability and homogenous high vascularity to reconstruct the suprafascial defect of IPSs. 22 The lower third gluteus maximus muscle harvested on an independent perforator, bestowed with freedom of mobility, facilitates the three-dimensional spatial positioning. This also provides a well-vascularized tissue to fill and obliterate congruently the large and deep subfascial void of the excised IPSs effectively to eschew the aforesaid complications.…”