Distal partial gluteus maximus musculocutaneous V-Y flap: a simplified technique for reconstruction of ischial pressure sores
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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.
KeywordsIschial pressure sore Myocutaneous flap Reconstruction Gluteus maximus
Compliance with ethical standards
Conflict of interest
Mustafa Nışancı and Mehmet Altıparmak declare that they have no conflict of interest.
This study was approved by “The Ethical Committee of Muğla Sıtkı Koçman University.”
Participation consent statement
Mustafa Nışancı: creation of the idea, executing the operations, collecting data.
Mehmet Altıparmak: executing the operations, collecting data, writing the manuscript.
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