The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region

Abstract

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

A Systematic Review Comparing Outcomes of Local Flap Options for Reconstruction of Pressure Sores

“…Studies on fasciocutaneous flaps for pressure sores have reported the overall complication rates as high as 40% and as low as 0% 5,14–17,47 . The complication rates in the perforator flaps is consistent with the studies we had considered for this review, which showed complication rates ranging from 1% to 21% 5,28,36 . The combined flaps had the lowest overall complication rate of 12.7%.…”

“…5,[14][15][16][17]47 The complication rates in the perforator flaps is consistent with the studies we had considered for this review, which showed complication rates ranging from 1% to 21%. 5,28,36 The combined flaps had the lowest overall complication rate of 12.7%. Although this number is lesser compared with the other types of flaps, it is a bit higher than the complication rates shown in the studies that we have included in this review where the highest reported overall complication rate was only 3%.…”

Volumetric Evaluation of Dead Space in Ischial Pressure Injuries Using Magnetic Resonance Imaging: A Case Series

“…An increasing number of studies use MRI for preoperative planning in plastic surgery, such as a study that identified the location of perforated vessels in a PI using MRI 37 and a study of 3D printed haptic analysis of a lumbosacral defect using MRI. 38 The authors suggest that this case series has two important implications.…”