Rotation advancement V-Y posterior thigh flap combined with a biceps femoris muscle flap for reconstruction of a recurrent ischial pressure sore in pediatric patients

Autor: Mahmoud A. Hifny
Rok vydání: 2020
Předmět:
Zdroj: European Journal of Plastic Surgery. 44:59-64
ISSN: 1435-0130
0930-343X
DOI: 10.1007/s00238-020-01684-2
Popis: Ischial pressure sores are mostly seen in wheelchair-bound pediatric patients, who are affected by a myelomeningocele, as a result of constant shearing force over the ischial region. The ischial sores are the most difficult to treat with high recurrence rates. Although there are various reconstructive modalities that are described for coverage of ischial pressure sores, there is still a long-term debate on an optimal method of reconstruction. Between April 2017 and June 2019, a total of 6 patients who were affected with a myelomeningocele anomalis were operated on for a total of 7 recurrent grade IV ischial ulcers. Data collection was done through analysis of medical records, which included the patients’ demography, operative details, and postoperative complications. A routine preoperative regimen including correction of the nutrition status and anemia should be ensured. We dissected a biceps femoris muscle turnover flap that obliterated the wound cavity and simultaneously applied a V-Y rotation advancement posterior thigh fasciocutaneous flap for coverage of ischial pressure sore surface. All flaps survived without early complications except for one case (14.2%) where a minor wound dehiscence had occurred and managed by secondary stitches. Among all 7 cases, only one (14.2%) had a recurrence 9 months after surgery, which required further debridement and advancement of the same flap. The mean follow-up period was 12.3 months (range, 4–24 months). Although there is still no ideal flap for closure of ischial pressure sores, the rotation advancement V-Y posterior thigh fasciocutaneous flap combined with a biceps femoris muscle turnover flap is considered a reliable reconstructive technique in pediatric patients. The present technique integrates the benefits of well-vascularized muscle tissue with a durable skin coverage that can be reused in cases of recurrence. Level of evidence: Level V, therapeutic study.
Databáze: OpenAIRE
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