Pelvic pressure sores reconstruction by the v–y advancement flaps: a 2-year experience

Background: Pressure ulcers have complex etiopathogenesis. They are localized mainly in the pelvic region over the bony prominences of sacral, ischial, and trochanteric areas. The fundamental surgical treatments are debridement with excision of the underlying bursa and the involved bone tissue, followed by tissue coverage. Aim: This study reports our experience in repairing pelvic pressure sores with the V–Y advancement flaps and analyzes our results in terms of morbidity and recurrence. Methods: A prospective study was conducted between Jan 2013 and Dec 2015 of 15 patients (11males, 4 females), withmean age of 43.5 years,with grade IV pelvic pressur sores (9 sacral, 6 ischial). 2 ulcerswere recurrent and 13 were primary. Themean ulcer size was 11.8 × 7.1 cm. The sacral bed sores were covered by the gluteus maximus (GM) fasciocutaneous V–Y advancement flaps (2 unilateral and 7 bilateral flaps) while the ischial bed sores were covered by the biceps femoris (BF) fasciocutaneous V–Y advancement flaps in 4 cases,BF myocutaneous V–Y advancement flap in 1case and vertical GM fasciocutaneous V–Y advancement flap in 1 case. Results: All flaps survived completely with no complications in 11 patients. Complications occurred in 4 cases (26.7%); (1 hematoma, 1 wound infection, 1 small wound dehiscence (1.5 cm) and 1 distal superficial flap necrosis), all treated conservatively without necessitating 2nd operation. During the follow up period from 8 to 20 months (mean- 13.2 months) only one case of ulcer recurrence (6.7%) that was treated by re-advancement of the same flap. Conclusion: We can conclude that the success of pressure ulcer surgery depends not only on the appropriate flap choice but also on patient education and compliance. However, the V–Y advancement flaps offer a reliable and robust coverage of sacral and ischial pressure sores even recurrent ones with minimal donor site morbidity, accepted rate of complications, low recurrence rate and preservation of future reconstructive options.