A novel external fixation of gluteus maximus muscle flap for reconstruction of refractory ischial tuberosity pressure ulcer

Abstract

Abstract Objective Treatment of the ischial tuberosity pressure ulcer remains a surgical challenge. Ischial-located flap reconstruction shares a high risk of wound dehiscence and recurrence. The aim of this study was to design a surgical procedure of the external fixation as a novel option for a modified reconstruction of ischial tuberosity sore. Methods Ten spastic paraparesis patients with ischial tuberosity pressure ulcers were enrolled in this study from June 2018 to March 2021. The defects occurred secondary to spinal injury (6 patients), ankylosing spondylitis (2 patients), infantile paralysis (1 patient) and Parkinson's syndrome (1 patient). The ischiogluteal bursa and lesioned part of ischial tuberosity were excised in all cases. The gluteus maximus muscle flaps ranged in size from 2cm × 8cm to 10cm × 10cm. The simple external fixation using stainless-steel suture tying over sterile gauze were applied to ensure the extermination of dead space and fixation of the gluteus maximus muscle flap. Results The obtained outcomes were satisfactory functionally and aesthetically. Pressure ulcers in 10 patients were completely healed without major problems, except one patient developed a new skin ulcer one week after discharge, which eventually healed after being reoperated the same procedure. All patients were satisfied with the application of the external fixation and proposed flaps. Conclusion In this series of 10 patients, all gluteus maximus muscle flaps were fixed and adhered to ischial tuberosity effectively and the pressure wounds were closed well when patients discharged.