Evaluation of the versatility of perforators-enhanced rhomboid flap technique for ischial sores reconstruction

Abstract

Background

Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management, are available. In flap surgery for pressure sores, a variety of flap types may be used; each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforator-enhanced rhomboid flap technique for ischial sore construction.

Methods

This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital. The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap. Postoperative follow-ups and evaluations were performed.

Results

The mean age of the study group was 43.7 ​± ​13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases. The mean surface area of sores was 24.8 ​± ​6.3 ​cm². In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ​± ​0.98 ​cm and required around 6.8 ​± ​1.9 weeks to heal.

Conclusion

The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.