BACKGROUND: Ischial pressure sores often recur, the surgical choice often troubled the surgeon, because surgery repair should consider future reconstructive procedures. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores by using an inferior gluteal artery of the descending branch perforator flap.
METHODS: A study involving patients suffering from ischial pressure sores was performed from March 2016 to August 2020. Patients with large defects, for which direct closure was not possible, underwent reconstructive surgery using an inferior gluteal artery descending branch perforator flap. Collected data included age, diabetes, wound culture, size of the wound, whether or not negative pressure therapy was received, operative time, intraoperative blood loss, and postoperative complications. Patients were followed up through outpatient visits or by telephone.
RESULTS: Five patients with ischial pressure sores (four primary and one recurrent) underwent reconstructive surgery with inferior gluteal artery descending branch perforator flap. One patient received colostomy and wound negative pressure therapy before lesion reconstruction. All patients successfully recovered without postoperative complications. The follow-up period ranged from 4 to 31 months. No wound disruption or recurrence was recorded.
CONCLUSIONS: Inferior gluteal artery descending branch perforator flap treatment of ischial pressure sores is a simple and feasible method for preserving the inferior gluteal artery\'s main vascular perforators and could be used as a future surgical option.

BACKGROUND: The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers.
METHODS: A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the \"The Atlas of the perforator arteries of the skin, the trunk and limbs\", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily.
RESULTS: A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory.
CONCLUSIONS: Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.