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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 177-185
DOI: 10.1055/s-0041-1729505
Original Article

Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores—A New Design

Dharanipriya Arikrishnan
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, India
,
Thalaivirithan Margabandu Balakrishnan 
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, India
,
Jaganmohan Janardhanam
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, India
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Abstract

Background “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator.

Aim and Methods After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same.

Results Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group (p < 0.045), and in only 3 patients of the control group.

Conclusions This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.

Keywords

recurrent pressure ulcer - ischial pressure ulcer - myelopathic patients - chimeric inferior gluteal artery perforator flap


Publikationsverlauf

Artikel online veröffentlicht:
05. Juli 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. In: Haesler E, ed. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Osborne Park, Australia: Cambridge Media 2014
  • 2 Dansereau JG, Conway H. Closure of decubiti in paraplegic. Report of 2000 Cases. Plast Reconstr Surg 1964; 33: 474-480
    CrossrefPubMedSuche in Google Scholar
  • 3 Kwon R, Janis JE. Pressure sores. In: Neligan PC, ed. Plastic Surgery. 4th ed. Philadelphia, PA:. Saunders Elsevier 2018; 351-382
    Suche in Google Scholar
  • 4 Chen Y, Devivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil 2005; 86 (06) 1208-1213
    CrossrefPubMedSuche in Google Scholar
  • 5 Cushing CA, Phillips LG. Evidence-based medicine: pressure sores. Plast Reconstr Surg 2013; 132 (06) 1720-1732
    CrossrefPubMedSuche in Google Scholar
  • 6 Lefèvre C, Bellier-Waast F, Lejeune F. et al. Ten years of myocutaneous flaps for pressure ulcers in patients with spinal lesions: analysis of complications in the framework of a specialised medical-surgical pathway. J Plast Reconstr Aesthet Surg 2018; 71 (11) 1652-1663
    CrossrefPubMedSuche in Google Scholar
  • 7 Berlemont M, Keromest R. Dangers of ischiectomy in ulcers in the paraplegic patient. Review of 236 records [in French]. Rev Chir Orthop Repar Appar Mot 1987; 73 (08) 656-664
    Suche in Google Scholar
  • 8 Culkin DJ, Wheeler Jr JS, Chintam R, Lopez E, Nemchausky BA. Perineal urethrocutaneous fistula complicating ischiectomy. J Urol 1988; 139 (04) 811-812
    CrossrefPubMedSuche in Google Scholar
  • 9 Burm JS, Hwang J, Lee YK. A new option for the reconstruction of primary or recurrent ischial pressure sores: hamstring-adductor magnus muscle advancement flap and direct closure. Ann Plast Surg 2018; 80 (04) 400-405
    CrossrefPubMedSuche in Google Scholar
  • 10 Kumar U, Jain P. Infragluteal fasciocutaneous flap for management of recurrent ischial pressure sore. Indian J Plast Surg 2018; 51 (01) 70-76
    Thieme ConnectPubMedSuche in Google Scholar
  • 11 Scheufler O, Farhadi J, Kovach SJ. et al. Anatomical basis and clinical application of the infragluteal perforator flap. Plast Reconstr Surg 2006; 118 (06) 1389-1400
    CrossrefPubMedSuche in Google Scholar
  • 12 Scheflan M, Nahai F, Bostwick III J. ScheflanM. Gluteus maximus island musculocutaneous flap for closure of sacral and ischial ulcers. Plast Reconstr Surg 1981; 68 (04) 533-538
    CrossrefPubMedSuche in Google Scholar
  • 13 Higgins JP, Orlando GS, Blondeel PN. Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg 2002; 55 (01) 83-85
    CrossrefPubMedSuche in Google Scholar
  • 14 Lee SS, Huang SH, Chen MC, Chang KP, Lai CS, Lin SD. Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap. J Plast Reconstr Aesthet Surg 2009; 62 (10) 1339-1346
    CrossrefPubMedSuche in Google Scholar
  • 15 Grassetti L, Scalise A, Lazzeri D. et al. Perforator flaps in late-stage pressure sore treatment: outcome analysis of 11-year-long experience with 143 patients. Ann Plast Surg 2014; 73 (06) 679-685
    CrossrefPubMedSuche in Google Scholar
  • 16 Cope C, Barry P, Hassall M, Barnett R, Richards M, Vandervord J. V-Y advancement hamstring myocutaneous island flap repair of ischial pressure ulcers. Aust N Z J Surg 1995; 65 (06) 412-416
    CrossrefPubMedSuche in Google Scholar
  • 17 Lemaire V, Boulanger K, Heymans O. Free flaps for pressure sore coverage. Ann Plast Surg 2008; 60 (06) 631-634
    CrossrefPubMedSuche in Google Scholar
  • 18 Korambayil PM, Allalasundaram K, Balakrishnan T. Perforator propeller flaps for sacral and ischial soft tissue reconstruction. Indian J Plast Surg 2010; 43 (02) 151-157
    CrossrefPubMedSuche in Google Scholar
  • 19 Legemate CM, van der Kwaak M, Gobets D, Huikeshoven M, van Zuijlen PP. The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: technique and long-term outcome of a cohort study. J Plast Reconstr Aesthet Surg 2018; 71 (06) 889-894
    CrossrefPubMedSuche in Google Scholar
  • 20 Friedrich JB, Pederson WC, Bishop AT, Galaviz P, Chang J. New workhorse flaps in hand reconstruction. Hand (N Y) 2012; 7 (01) 45-54
    CrossrefPubMedSuche in Google Scholar
  • 21 Balakrishnan TM, Alalasundaram KV. Reconstruction in the revascularized diabetic foot. J Diab Foot Complications 2012; 4 (02) 46-56
    Suche in Google Scholar
  • 22 Balakrishnan TM, Mariappan BK, Jaganmohan J. Retrospective cohort observational study on the single best perforator-based Pacman flap in the reconstruction of stage iv sacral region pressure ulcers. Indian J Plast Surg 2020; 53 (02) 266-272
    Thieme ConnectPubMedSuche in Google Scholar
  • 23 Ku I, Lee GK, Yoon S, Jeong E. A dual padding method for ischial pressure sore reconstruction with an inferior gluteal artery perforator fasciocutaneous flap and a split inferior gluteus maximus muscle flap. Arch Plast Surg 2019; 46 (05) 455-461
    Thieme ConnectPubMedSuche in Google Scholar
  • 24 Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J. A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg 2012; 130 (01) 67e-77e
    CrossrefPubMedSuche in Google Scholar
  • 25 Singh R, Singh R, Rohilla RK, Siwach R, Verma V, Kaur K. Surgery for pressure ulcers improves general health and quality of life in patients with spinal cord injury. J Spinal Cord Med 2010; 33 (04) 396-400
    CrossrefPubMedSuche in Google Scholar
  • 26 Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L. Impact of pressure ulcers on individuals living with a spinal cord injury. Arch Phys Med Rehabil 2014; 95 (12) 2312-2319
    CrossrefPubMedSuche in Google Scholar
  • 27 Daniel RK, Priest DL, Wheatley DC. Etiologic factors in pressure sores: an experimental model. Arch Phys Med Rehabil 1981; 62 (10) 492-498
    PubMedSuche in Google Scholar
  • 28 Nola GT, Vistnes LM. Differential response of skin and muscle in the experimental production of pressure sores. Plast Reconstr Surg 1980; 66 (05) 728-733
    CrossrefPubMedSuche in Google Scholar
  • 29 Kuo PJ, Chew KY, Kuo YR, Lin PY. Comparison of outcomes of pressure sore reconstructions among perforator flaps, perforator-based rotation fasciocutaneous flaps, and musculocutaneous flaps. Microsurgery 2014; 34 (07) 547-553
    CrossrefPubMedSuche in Google Scholar
  • 30 Vasconez LO, Bostwick III J, McCraw J. Coverage of exposed bone by muscle transposition and skin grafting. Plast Reconstr Surg 1974; 53 (05) 526-530
    CrossrefPubMedSuche in Google Scholar
  • 31 Minami RT, Mills R, Pardoe R. Gluteus maximus myocutaneous flaps for repair of pressure sores. Plast Reconstr Surg 1977; 60 (02) 242-249
    CrossrefPubMedSuche in Google Scholar
  • 32 Ger R, Levine SA. The management of decubitus ulcers by muscle transposition. An 8-year review. Plast Reconstr Surg 1976; 58 (04) 419-428
    CrossrefPubMedSuche in Google Scholar
  • 33 Foster RD, Anthony JP, Mathes SJ, Hoffman WY. Ischial pressure sore coverage: a rationale for flap selection. Br J Plast Surg 1997; 50 (05) 374-379
    CrossrefPubMedSuche in Google Scholar