The Treatment of Trochanteric Pressure Sore Using Superior or Inferior Gluteal Artery Perforator Flap

상.하둔동맥 천공지피판을 이용한 대전자부 욕창의 치료

  • Tark, Woo-Hyun (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lee, Won-Jai (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Yun, In-Sik (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Rah, Dong-Kyun (Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine)
  • 탁우현 (연세대학교 의과대학 성형외과학교실) ;
  • 이원재 (연세대학교 의과대학 성형외과학교실) ;
  • 윤인식 (연세대학교 의과대학 성형외과학교실) ;
  • 나동균 (연세대학교 의과대학 성형외과학교실)
  • Received : 2011.03.19
  • Accepted : 2011.04.14
  • Published : 2011.05.10

Abstract

Purpose: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. Methods: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. Results: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. Conclusion: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

Keywords

References

  1. Paletta CE, Freedman B, Shehadi SI: The VY tensor fasciae latae musculocutaneous flap. Plast Reconstr Surg 83: 852, 1989 https://doi.org/10.1097/00006534-198905000-00012
  2. Lynch SM: The bilobed tensor fascia lata myocutaneous flap. Plast Reconstr Surg 67: 796, 1981 https://doi.org/10.1097/00006534-198106000-00015
  3. Disa JJ, Carlton JM, Goldberg NH: Efficacy of operative cure in pressure sore patients. Plast Reconstr Surg 89: 272, 1992 https://doi.org/10.1097/00006534-199202000-00012
  4. Mandrekas AD, Mastorakos DP: The management of decubitus ulcers by musculocutaneous flaps: a five-year experience. Ann Plast Surg 28: 167, 1992 https://doi.org/10.1097/00000637-199202000-00007
  5. Tavakoli K, Rutkowski S, Cope C, Hassall M, Barnett R, Richards M, Vandervord J: Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study. Br J Plast Surg 52: 476, 1999 https://doi.org/10.1054/bjps.1999.3126
  6. Koshima I, Moriguchi T, Soeda S, Kawata S, Ohta S, Ikeda A: The gluteal perforator-based flap for repair of sacral pressure sores. Plast Reconstr Surg 91: 678, 1993 https://doi.org/10.1097/00006534-199304000-00017
  7. Cos¸kunfirat OK, Ozgentas HE: Gluteal perforator flaps for coverage of pressure sores at various locations. Plast Reconstr Surg 113: 2012, 2004 https://doi.org/10.1097/01.PRS.0000122215.48226.3F
  8. Seyhan T, Ertas NM, Bahar T, Borman H: Simplified and versatile use of gluteal perforator flaps for pressure sores. Ann Plast Surg 60: 673, 2008 https://doi.org/10.1097/SAP.0b013e318141f742
  9. Scheufler O, Farhadi J, Kovach SJ, Kukies S, Pierer G, Levin LS, Erdmann D: Anatomical basis and clinical application of the infragluteal perforator flap. Plast Reconstr Surg 118: 1389, 2006 https://doi.org/10.1097/01.prs.0000239533.39497.a9
  10. Bauer J, Phillips LG: MOC-PSSM CME article: pressure sores. Plast Reconstr Surg 121: 1, 2008
  11. Sorensen JL, Jorgensen B, Gottrup F: Surgical treatment of pressure ulcers. Am J Surg 188: 42, 2004 https://doi.org/10.1016/S0002-9610(03)00290-3
  12. Ishida LH, Munhoz AM, Montag E, Alves HR, Saito FL, Nakamoto HA, Ferreira MC: Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores. Plast Reconstr Surg 116: 1346, 2005 https://doi.org/10.1097/01.prs.0000182222.66591.06
  13. Bravo FG, Schwarze HP: Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 62: 602, 2009 https://doi.org/10.1016/j.bjps.2008.11.086
  14. Blondeel PN, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G: Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51: 202, 1998 https://doi.org/10.1016/S0007-1226(98)80010-6