Treatment of Ischial Pressure Sores with Both Profunda Femoris Artery Perforator Flaps and Muscle Flaps

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

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Profunda Femoris Artery Perforator Propeller Flap

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000000432 ◽

2015 ◽

Vol 3 (8) ◽

pp. e487 ◽

Cited By ~ 4

Author(s):

Alessandro Scalise ◽

Caterina Tartaglione ◽

Elisa Bolletta ◽

Marina Pierangeli ◽

Giovanni Di Benedetto

Keyword(s):

Profunda Femoris Artery ◽

Propeller Flap ◽

Artery Perforator ◽

Profunda Femoris

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Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000003289 ◽

2020 ◽

Vol 8 (12) ◽

pp. e3289

Author(s):

Ryo Karakawa ◽

Hidehiko Yoshimatsu ◽

Erisa Maeda ◽

Tomoyoshi Shibata ◽

Kenta Tanakura ◽

...

Keyword(s):

Perforator Flap ◽

Profunda Femoris Artery ◽

Artery Perforator ◽

Profunda Femoris

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Medium- and Large-Sized Autologous Breast Reconstruction using a Fleur-de-lys Profunda Femoris Artery Perforator Flap Design: A Report Comparing Results with the Horizontal Profunda Femoris Artery Perforator Flap

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1649508 ◽

2018 ◽

Vol 35 (01) ◽

pp. 008-014 ◽

Cited By ~ 5

Author(s):

Martin Lhuaire ◽

Kevin Haddad ◽

Francesco-Saverio Wirz ◽

Samah Abedalthaqafi ◽

Déborah Obadia ◽

...

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Perforator Flap ◽

Skin Surface ◽

Complication Rates ◽

Skin Paddle ◽

Profunda Femoris Artery ◽

Flap Design ◽

Artery Perforator ◽

Profunda Femoris

Background The volume of the profunda femoris artery perforator (PAP) flap limits its indications to small- and medium-sized breast reconstructions after modified radical mastectomy for cancer. We report a modified PAP flap design, including not only a vertical extension that increases its volume but also the skin surface, which suits larger breasts requiring immediate or delayed breast reconstructions and compare the results with our horizontal skin paddle PAP flap experience. Patients and Methods In our center between November 2014 and November 2016, 51 consecutive patients underwent a PAP flap breast reconstruction following breast cancer. A retrospective analysis on the collected data was performed to compare 34 patients with a bra cup smaller than C who underwent 41 horizontal PAP flap procedures, with those (n = 17) of a bra cup greater than or equal to C who underwent 21 fleur-de-lys PAP flap procedures. Demographic, anthropometric, flap and surgical characteristics, postoperative complication rates, and hospital stay were compared between the two groups. Results The average flap weight was 480 g (range: 340–735 g) for the fleur-de-lys PAP flap group compared with 222 g (range: 187–325 g) for the horizontal PAP flap procedure (p < 0.001). The mean flap dimensions were 25 × 18 cm for the fleur-de-lys PAP flap group compared with 25 × 7 cm in the horizontal PAP flap group. No flap failure was observed in the fleur-de-lys PAP flap group compared with two flap failures secondary to venous thrombosis in the horizontal PAP flap group (NS). Three patients (14%) experienced delayed healing at the donor site compared with four patients (10%) in the horizontal PAP flap group (NS). Conclusion The fleur-de-lys skin paddle design not only allows an increase of the horizontal PAP flap volume, but also increases the skin surface, with an acceptable donor site morbidity. For medium- or large-sized breasts, the fleur-de-lys PAP flap seems to be ideal when a DIEP flap-based reconstruction is contraindicated.

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