TY - JOUR
T1 - The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study
T2 - Technique and long-term outcome of a cohort study
AU - Legemate, Catherine M.
AU - van der Kwaak, Monique
AU - Gobets, David
AU - Huikeshoven, Menno
AU - van Zuijlen, Paul P. M.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background: The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. Methods: A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery). Results: Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers. Conclusions: The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.
AB - Background: The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. Methods: A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery). Results: Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers. Conclusions: The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity.
KW - Internal pudendal artery
KW - Ischial pressure sore
KW - Ischial pressure ulcer
KW - Perforator flap
KW - Reconstruction
KW - Spinal cord injury
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044625863&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29428586
UR - http://www.scopus.com/inward/record.url?scp=85044625863&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bjps.2018.01.032
DO - https://doi.org/10.1016/j.bjps.2018.01.032
M3 - Article
C2 - 29428586
SN - 1748-6815
VL - 71
SP - 889
EP - 894
JO - Journal of plastic, reconstructive & aesthetic surgery
JF - Journal of plastic, reconstructive & aesthetic surgery
IS - 6
ER -