medigraphic.com
ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2018, Number 2

<< Back Next >>

Cir Plast 2018; 28 (2)

Hamstring rotation flap variant for ischial ulcer reconstruction

Espino GI, Apellaniz CA, Rodríguez RC, Nahas CL, Altamirano AC, Chávez SE, Vargas FE

Language: Spanish
References: 24
Page: 87-91
PDF size: 427.88 Kb.


ABSTRACT

The Hamstring flap is a valid option for the reconstruction of ischial ulcers. Pressure ulcers represent a real challenge for the plastic surgeon. They require specialized and multidisciplinary treatment due to their high probability of recurrence and complications in their handling. Usually, they are caused by sustained pressure on the ischial tuberosity. The case is presented of a paraplegic patient who had myelomeningocele from birth and a current diagnosis of ischial ulcer. Multiple attempts at surgical closure were performed over 3 years, alternating with conservative measures, but without success. On physical examination, he presented a left ischial ulcer of 6 x 6 cm, which was cleaned and surgically debrided, and closed by means of a modified Hamstring flap. On day seven, he presented wound dehiscence which was managed conservatively and had deferred primary closure at four weeks. At eight months after surgery, the patient has evolved well and had an acceptable aesthetic and functional result. In addition, this problem has not recurred, which has allowed him to return to his job and keep a good physical-psycho-emotional balance. The objective of this flap is to provide coverage to the ischial area without affecting adjacent structures, which requires ample knowledge of the anatomy of the femoral region, as well as the local and regional flaps that we can use for reconstruction. Currently this flap is an effective therapeutic option for the treatment of refractory ischial ulcers in centers that have plastic surgeons who are not specialized in microsurgery.


REFERENCES

  1. Jordan SW, De la Garza M, Lewis VL Jr. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: technique and outcomes over 8-years. J Plast Reconstr Aesthet Surg 2017; 70 (7): 959-966.

  2. Llanos S et al. Colgajo miocutáneo de glúteo mayor en isla con cierre V en Y para la cobertura de úlceras isquiáticas. Cir Plast Iberolatinam 2006; 32 (1): 41-48.

  3. Anders J et al. Decubitus ulcers: pathophysiology and primary prevention. Dtsch Arztebl Int 2010; 107: 371-381-quiz 382.

  4. Middleton JW, Lim K, Taylor L et al. Patterns of morbidity and re-hospitalization following spinal cord injury. Spinal Cord 2004; 42: 359-367.

  5. Bamba R et al. Flap reconstruction for pressure ulcers: an outcomes analysis. Plast Reconstr Surg Glob Open 2017; 5 (1): e1187. doi: 10.1097/GOX.0000000000001187.

  6. Purcell RL, Cody JP, O’Donnell M, Andersen R, Rodriguez CJ, Tintle S. Pelvic floor reconstruction utilizing a residual hamstring rotational flap following traumatically induced subtotal hemipelvectomy in a combat blast casualty: a case report. Mil Med 2016; 181 (9): e1172-1176.

  7. Cushing CA, Phillips LG. Evidence-based medicine: pressure sores. Plast Reconstr Surg 2013; 132 (6): 1720-1732.

  8. Marchi M, Battaglia S, Marchese S, Intagliata E, Spartaro C, Vecchio R. Surgical reconstructive procedures for treatment of ischial, sacral and trochanteric pressure ulcers. G Chir 2015; 36 (3): 112-116.

  9. Lin H, Hou C, Chen A, Xu Z. Treatment of ischial pressure sores using a modified gracilis myofasciocutaneous flap. J Reconstr Microsurg 2010; 26 (3): 153-157.

  10. Kuo PJ, Chew KY, Kuo YR et al. Comparison of outcomes of pressure sore reconstructions among perforator flaps, perforator-based rotation fasciocutaneous flaps, and musculocutaneous flaps. Microsurgery 2014; 34: 547-553.

  11. Hurteau JE, Bostwick J, Nahai F, Hester R, Jurkiewics MJ. V-Y advancement of hamstring musculocutaneous flap for coverage of ischial pressure sores. Plast Reconstr Surg 1981; 68: 539-542.

  12. Jósvay J, Donath A. Modified Hamstring Musculocutaneous flap for the coverage of ischial pressure sores. Plast Reconstr Surg 1999; 103 (6): 1715-1718.

  13. Burm JS, Hwang J, Lee YK. A new option for the reconstruction of primary or recurrent ischial pressure sores: hamstring-adductor magnus muscle advancement flap and direct closure. Ann Plast Surg 2018; 80 (4): 400-405.

  14. Battermann N, Appell HJ, Dargel J, Koebke J. An anatomical study of the proximal hamstring muscle complex to elucidate muscle strains in this region. Int J Sports Med 2011; 32 (3): 211-215.

  15. Van der Made AD, Wieldraaijer T, Kerkhoffs GM, Kleipool RP, Engebretsen L, van Dijk CN, Golanó P. The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc. 2015; 23 (7): 2115-2122.

  16. Woodley SJ, Mercer SR. Hamstring muscles: architecture and innervation. Cells Tissues Organs 2005; 179: 125-141.

  17. Mathes SJ, Nahai F. Regional flaps: anatomy and basic techniques/thigh. clinical atlas of muscle and musculocutaneous flaps. Ed. Mosby 1979.

  18. Keys KA, Daniali LN, Warner KJ, Mathes DW. Multivariate predictors of failure after flap coverage of pressure ulcers. Plast Reconstr Surg 2010; 125 (6): 1725-1734.

  19. Niederhauser A, Lukas CV, Parker V, Ayello EA, Zulkowski K, Berlowitz D. Comprehensive programs for preventing pressure ulcers: a review of the literature. Adv Skin Wound Care 2012; 25 (4): 167-188.

  20. Tavakoli K, Rutkowski S, Cope C et al. Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: An 8-year study. Br J Plast Surg 1999; 52: 476-479.

  21. Evans G, Dufresne C, Manson P. Surgical correction of pressure ulcers in an urban center: is it efficacious? Adv Wound Care 1994; 7: 40-46.

  22. Chiu YJ, Liao WC, Wang TH, Shih YC, Ma H, Lin CH, Wu SH, Perng CK. A Retrospective study: multivariate logistic regression analysis of the outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous and perforator flaps. J Plast Reconstr Aesthet Surg 2017; 70 (8): 1038-1043.

  23. Cope C, Barry P, Hassall M, Barnett R, Richards M, Vandervord J. V-y advancement hamstring myocutaneous island flap repair of ischial pressure ulcers. ANZ J Surg 1995; 65 (6): 412-416.

  24. Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J. A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg 2012; 130 (1): 67e-77e.




2020     |     www.medigraphic.com