Dual-Plane Gluteal Flap for Reconstruction of Ischial Tuberosity Pressure Wounds
Catherine J. Sinnott, MD, Martin Benjamin, MD, Ahmed E. Nasser, MD, Laurence T. Glickman, MD, Thomas A. Davenport, MD.
Long Island Plastic Surgical Group, Garden City, NY, USA.
BACKGROUND: Ischial tuberosity pressure wounds are the most common type of pressure wounds and contribute to a large percentage of the total cost of surgical and non-surgical management of pressure wounds. Gluteal fasciocutaneous and myocutaneous flaps are well-documented methods of coverage for ischial pressure wounds. This study aimed to describe results using a novel “dual-plane” gluteal myocutaneous flap for reconstruction of ischial tuberosity pressure wounds. METHODS: A “dual-plane” gluteal myocutaneous flap was created by partially elevating the fasciocutaneous layer off the gluteus maximus muscle, allowing for independent rotation of the muscle flap. The gluteal muscle flap was then rotated into the ischial pressure wound defect and sutured in place. The fasciocutaneous layer of the flap was then mobilized and positioned over the muscle flap and donor defect and closed primarily in three layers. Elevating the gluteal myocutaneous flap in this “dual-plane” approach allows for further rotation of the gluteal muscle into the defect, while freeing the fasciocutaneous layer to close the flap and donor defect. A retrospective chart review was performed of all patients who underwent “dual-plane” gluteal myocutaneous flap reconstruction performed by a single surgeon from 2012 to 2018. Patient demographic characteristics as well as clinical and operative characteristics were reviewed. Outcomes were assessed by analyzing complication rates including, recurrence, need for revision surgery, wound infection, seroma, hematoma, dehiscence and necrosis. RESULTS: 8 “dual-plane” gluteal myocutaneous flaps were performed for reconstruction of ischial tuberosity pressure wound defects in 7 male patients with a mean age was 49.1±14.9 years (mean±S.D) and mean body mass index (BMI) of 26.7±6.4 kg/m2. All patients were non-ambulatory secondary to spinal cord injury or congenital neurological disease. Two patients (28.6%) were diabetic and one patient (14.3%) was an active smoker. The mean defect size after debridement of ischial pressure wounds was 60.8±32.2 cm2. After a mean follow up of 16.4 months, partial wound dehiscence occurred in one patient (14.3%) and was managed with local wound care only. Infection and recurrence occurred in another patient (14.3%) and required revision surgery. There were no cases of necrosis, seroma or hematoma.
CONCLUSIONS: The “dual-plane” gluteal myocutaneous flap is a viable method for reconstruction of ischial tuberosity pressure wounds. Elevating the fasciocutaneous layer of the flap off the gluteal muscle, allows for greater mobility and rotation of the muscle flap into the ischial pressure wound defect and closure of the flap and donor site with the fasciocutaneous layer.
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