Reconstruction of Trochanteric Pressure Sores using Perforator-based Flap from the Ascending Branch of Lateral Circumflex Femoral Artery

외측대퇴회선동맥 상행가지의 천공지피판을 이용한 대전자부 욕창의 재건

  • Kim, Jun-Hyung (Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital) ;
  • Eo, Su-Rak (Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital) ;
  • Cho, Sang-Hun (Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital)
  • 김준형 (동국대학교 의과대학 일산병원 성형외과학교실) ;
  • 어수락 (동국대학교 의과대학 일산병원 성형외과학교실) ;
  • 조상헌 (동국대학교 의과대학 일산병원 성형외과학교실)
  • Received : 2010.04.16
  • Accepted : 2010.07.19
  • Published : 2010.09.10

Abstract

Purpose: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. Methods: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. Results: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was $6{\times}4\;cm$. The largest flap dimension was $14{\times}7\;cm$. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. Conclusion: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.

Keywords

References

  1. Foster RD: Pressure sores. Mathes plastic surgery 2nd ed, Philadelphia, Saunders, 2006, p 1317
  2. Nahai F, Silverton JS, Hill HL, Vasconez LO: The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1: 372, 1978 https://doi.org/10.1097/00000637-197807000-00003
  3. Bovet JL, Nassif TM, Guimberteau JC, Baudet J: The vastus lateralis musculocutaneous flap in the repair of trochanteric pressure sores: technique and indications. Plast Reconstr Surg 69: 830, 1982 https://doi.org/10.1097/00006534-198205000-00020
  4. Hurwitz DJ, Swartz WM, Mathes SJ: The gluteal thigh flap: a reliable, senate flap for the closure of buttock and perineal wounds. Plast Reconstr Surg 68: 521, 1981 https://doi.org/10.1097/00006534-198110000-00008
  5. Levi B, Rees R: Diagnosis and management of pressure ulcers. Clin Plastic Surg 34: 735, 2007 https://doi.org/10.1016/j.cps.2007.07.007
  6. Dansereau JG, Conway H: Closure of decubiti in paraplegics: Report on 2000 cases. Plast Reconstr Surg 33: 474, 1964 https://doi.org/10.1097/00006534-196405000-00008
  7. Yamamoto Y, Tsutsumida A, Murazumi M, Sugihara T: Long-term outcome of pressure sores treated with flap coverage. Plast Reconstr Surg 100: 1212, 1997 https://doi.org/10.1097/00006534-199710000-00021
  8. Scheflan M: The tensor fascia lata: variations on a theme. Plast Reconstr Surg 68: 59, 1981 https://doi.org/10.1097/00006534-198107000-00013
  9. 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
  10. 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
  11. Coskunfirat 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
  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