Triple Coverage of Ischial Ulcers with Adipofascial Turnover and Fasciocutaneous Flaps

Abstract

Despite a wide variety of flap options, ischial ulcers remain the most difficult pressure ulcers to treat. This article describes the authors' successful surgical procedure for coverage of ischial ulcers using adipofascial turnover flaps combined with a local fasciocutaneous flap. After debridement, the adipofascial flaps are harvested both cephalad and caudal to the defect. The flaps are then turned over to cover the exposed bone in a manner so as to overlap the two flaps. A local fasciocutaneous flap (Limberg flap) is applied to the raw surface of the turnover flaps. Twenty-two patients with ischial ulcers were treated using this surgical procedure. Overall, 86.4 percent of the flaps (19 of 22) healed primarily. Triple coverage with the combination of double adipofascial turnover flaps and a local fasciocutaneous flap allows for an easily performed and minimally invasive procedure, preservation of future flap options, and a soft-tissue supply sufficient for covering the prominence and bony prominence and filling dead space. This technique provides successful soft-tissue reconstruction for minor to moderate-size ischial pressure ulcers.

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way

“…15 Nevertheless, fasciocutaneous and the most recent fasciocutaneous perforator flaps have been used successfully and, for some authors, with a lower rate of recurrence. [16][17][18][19][20] The type of myocutaneous or fasciocutaneous flap that should be used is still disputed. Our main purpose was to identify an effortless and effective surgical method to approach either primary or secondary ischial ulcers in paraplegic patients, to combine the advantages of both fasciocutaneous and muscle flaps by using two different and independent flaps.…”

The ′reading man flap′ for pressure sore reconstruction

“…Although the local fasciocutaneous flaps like the Limberg flap has stable circulation, they are inappropriate for large skin defects because inappropriate wound tension occurs, leading to dehiscence. [12]…”

Chirurginis pragulų gydymas Kauno medicinos universiteto klinikų Plastinės chirurgijos ir nudegimų skyriuje 1996–2005 metais

“…Analizuojamu laikotarpiu buvo operuojami visi pragulø turintys ligoniai (n = 108). Treèios ir ketvirtos stadijos pragulas rekomenduojama gydyti chirurginiu bûdu [18,19,20]. Operacinis pragulø gydymas buvo pargrástas trimis taisyklëmis.…”

“…Operacinis pragulø gydymas buvo pargrástas trimis taisyklëmis. Pirmoji -þaizdos nekrektomija; antroji, jei yra kaulo paþeidimas, -dalinë ar visiðka osteoektomija; treèioji -þaizdos uþdengimas greta esanèiais audiniais [7,19,20]: pragulos ekscizija ir uþdengimas aplinkiniais audiniais -odos lopu, raumeniniu odos lopu, fasciniu odos lopu. Lopo pasirinkimas priklauso ne tik nuo pragulos lokalizacijos, dydþio, gylio, bet svarbu, kad bûtø kuo maþesnis siûlës tempimas, prasiskyrimo pavojus.…”

“…Jei pragula yra ties kryþkauliu, atliekamos operacijos naudojant sukamuosius fasciokutaninius lopus Griffitho ar Conway metodu, arba miokutaninius sukamuosius m. gluteus maximus lopus, gali bûti atliekama V-Y pastumiamojo miokutaninio lopo operacija. Kai pragula atsiradusi ties trochanter major femoris sritimi, naudojami ðlaunies plaèiosios fascijos arba keturgalvio ðlaunies raumens lateralinës galvos lopai [7,[19][20][21][22].…”