Distal partial gluteus maximus musculocutaneous V-Y flap: a simplified technique for reconstruction of ischial pressure sores

  • Mustafa Nışancı
  • Mehmet AltıparmakEmail author
Original Paper



Ischial pressure sores are mostly seen in wheelchair-bound patients and they have a high risk of recurrence due to a multitude of reasons compared with sacral and trochanteric ulcers. Various treatment modalities have been presented but high recurrence rates maintain its importance.


Between 2009 and 2016, a total of 14 patients with spinal cord injuries were operated on for a total of 17 Shea stage IV ischial ulcers with the described technique. Demographic variables were recorded. Postoperative outcomes were categorized as early and late complications. A partial distal portion of gluteus maximus muscle (not the whole) was dissected and freed from the femoral insertion. The muscle was used as a carrier for the triangular flap lying above. The muscle was transposed medially and the triangular flap was advanced in a V-Y fashion to cover the defect.


The follow-up periods ranged between 15 and 61 months. Among all the 14 patients, only one (7.1%) had a recurrence after 1 year postoperatively which needed an additional debridement and advancement of the previous flap. This patient had a non-recurrent period of 16 months after the second operative procedure. Wound dehiscence, as an early complication, was seen in one patient which healed secondarily.


The distal partial gluteus maximus musculocutaneous V-Y flap is a simple and new approach with low complication rates for reconstruction of ischial pressure sores. Although there is still not an ideal flap for this challenge, the present technique could be a reliable option for the reconstructive armamentarium.Level of evidence: Level IV, therapeutic study.


Ischial pressure sore Myocutaneous flap Reconstruction Gluteus maximus 


Compliance with ethical standards

Funding information

Not applicable.

Conflict of interest

Mustafa Nışancı and Mehmet Altıparmak declare that they have no conflict of interest.

Ethical approval

This study was approved by “The Ethical Committee of Muğla Sıtkı Koçman University.”

Informed consent

Not applicable.

Participation consent statement

Mustafa Nışancı: creation of the idea, executing the operations, collecting data.

Mehmet Altıparmak: executing the operations, collecting data, writing the manuscript.


  1. 1.
    Eslami V, Saadat S, Habibi Arejan R, Vaccaro AR, Ghodsi SM, Rahimi-Movaghar V (2012) Factors associated with the development of pressure ulcers after spinal cord injury. Spinal Cord 50(12):899–903CrossRefGoogle Scholar
  2. 2.
    Kua EHJ, Wong CH, Ng SW, Tan KC (2011) The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers. J Plast Reconstr Aesthet Surg 64(1):e21–e23CrossRefGoogle Scholar
  3. 3.
    Otto A, Wechselberger G, Schoeller T (1998) Ischial pressure sore coverage: a rationale for flap selection. Br J Plast Surg 51(3):260–261CrossRefGoogle Scholar
  4. 4.
    Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T (2004) Triple coverage of ischial ulcers with adipofascial turnover and fasciocutaneous flaps. Plast Reconstr Surg 114(4):901–905CrossRefGoogle Scholar
  5. 5.
    Shea JD (1975) Pressure sores: classification and management. Clin Orthop Relat Res (112):89–100Google Scholar
  6. 6.
    Jordan SW, De la Garza M, Lewis VL (2017) Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: technique and outcomes over 8 years. J Plast Reconstr Aesthet Surg 70(7):959–966CrossRefGoogle Scholar
  7. 7.
    Keys KA, Daniali LN, Warner KJ, Mathes DW (2010) Multivariate predictors of failure after flap coverage of pressure ulcers. Plast Reconstr Surg 125(6):1725–1734CrossRefGoogle Scholar
  8. 8.
    Unal C, Ozdemir J, Yirmibesoglu O, Yucel E, Agir H (2012) Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage. Ann Plast Surg 69(1):67–72CrossRefGoogle Scholar
  9. 9.
    Tavakoli K, Rutkowski S, Cope C, Hassall M, Barnett R, Richards M, Vandervord J (1999) Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study. Br J Plast Surg 52(6):476–479CrossRefGoogle Scholar
  10. 10.
    Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J (2012) A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg 130(1):67–77CrossRefGoogle Scholar
  11. 11.
    Demirseren ME, Ceran C, Aksam B, Demiralp CO (2016) Clinical experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap for the reconstruction of ischial pressure ulcers. Ann Plast Surg 77(1):93–96CrossRefGoogle Scholar
  12. 12.
    Ahluwalia R, Martin D, Mahoney JL (2010) The operative treatment of pressure wounds: a 10-year experience in flap selection. Int Wound J 7(2):103–106CrossRefGoogle Scholar
  13. 13.
    Acartürk TO (2009) Treatment of large ischial ulcers communicating with the hip joint with proximal femoral resection and reconstruction with a combined vastus lateralis, vastus intermedius and rectus femoris musculocutaneous flap. J Plast Reconstr Aesthet Surg 62(11):1497–1502CrossRefGoogle Scholar
  14. 14.
    J. Hong, T. Goh, D. Choi, … J. K.-P. and, and undefined 2017, “The efficacy of perforator flaps in the treatment of chronic osteomyelitis,”
  15. 15.
    Hong JP, Goh TLH, Choi DH, Kim JJ, Suh HS (2017) The efficacy of perforator flaps in the treatment of chronic osteomyelitis. Plast Reconstr Surg 140(1):179–188Google Scholar
  16. 16.
    Nisanci M, Sahin I, Eski M, Alhan D (2015) A new flap alternative for trochanteric pressure sore coverage: Distal gluteus maximus musculocutaneous advancement flap. Ann Plast Surg 74(2):214–219Google Scholar
  17. 17.
    Santanelli Di Pompeo F, Longo B, Pagnoni M, Laporta R (2015) Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients. Microsurgery 35(4):279–283CrossRefGoogle Scholar
  18. 18.
    Lee S-S, Huang S-H, Chen M-C, Chang K-P, Lai C-S, Lin S-D (2009) Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap. J Plast Reconstr Aesthet Surg 62(10):1339–1346CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Plastic, Rekonstructive and Aesthetic SurgeryMuğlaTurkey

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