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European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 3/2020

01-06-2020 | Original Paper

Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores

Author: Mehmet Altıparmak

Published in: European Journal of Plastic Surgery | Issue 3/2020

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Abstract

Background

Ischial sores have higher risks of recurrence and considered the most difficult to treat. There are mainly 2 groups of techniques used in ischial pressure sore reconstruction which are as follows: (1) fasciocutaneous and/or myocutaneous flaps (Fc/Mc) and (2) perforator flaps. The aim of this study is to determine the advantages of perforator flaps over Fc and/or Mc flaps in reconstruction of ischial pressure ulcers.

Methods

All articles published before April 2018 were investigated and searched for eligibility using the databases PubMed and Google Scholar. Eligible studies were determined according to inclusion and exclusion criteria. Recurrence rates, complication rates, and time of recurrences were assessed.

Results

A total of 15 studies with 279 patients and 305 flaps were identified and included in the final analysis. The overall recurrence rate of flaps was 6.31 (95% CI, 5.86 to 6.78; p < 0.001); complication rate of flaps was 3.06 (95% CI, 2.91 to 3.23; p < 0.001); and recurrence time of flaps was 0.77 (95% CI, 0.66 to 0.90; p < 0.001). The mixed-effects analysis results have revealed that there was no statistically significant difference between the perforator and the Fc/Mc groups (between-level) in terms of recurrence rates (p > 0.05), complication rates (p > 0.05), and time of recurrences (p > 0.05).

Conclusions

Perforator flaps mandate thorough pre-operative preparations, meticulous dissections, and long surgery times. There seem no advantage in applying perforator flaps in ischial pressure sore reconstructions in terms of complications and recurrences. Surgeons may prefer to perform straightforward procedures, such as myocutaneous flaps.
Level of evidence: Level IV, risk/prognostic, therapeutic study.
Literature
1.
Kua EHJ, Wong CH, Ng SW, Tan KC (2011) The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers. J Plast Reconstr Aesthetic Surg. 64(1):e21–e23
2.
Chiu YJ, Liao WC, Wang TH et al (2017) A retrospective study: multivariate logistic regression analysis of the outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous, and perforator flaps. J Plast Reconstr Aesthetic Surg. 70(8):1038–1043
3.
Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T (2004) Triple coverage of ischial ulcers with adipofascial turnover and fasciocutaneous flaps. Plast Reconstr Surg. 114(4):901–905PubMed
4.
Thiessen FE, Andrades P, Blondeel PN et al (2011) Flap surgery for pressure sores: should the underlying muscle be transferred or not? J Plast Reconstr Aesthetic Surg. 64(1):84–90
5.
Iida N, Watanabe A (2015) Usefulness of simple-designed bilobed flap for reconstruction of ischial decubitus ulcer. Plast Reconstr surgery Glob open. 3(9):e525
6.
Djedovic G, Morandi EM, Metzler J et al (2017) The posterior thigh flap for defect coverage of ischial pressure sores—a critical single-centre analysis. Int Wound J. 14(6):1154–1159PubMed
7.
8.
Lee JT, Cheng LF, Lin CM, Wang CH, Huang CC, Chien SH (2007) A new technique of transferring island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of recurrent ischial pressure sores. J Plast Reconstr Aesthetic Surg. 60(9):1060–1066
9.
Acartürk TO (2009) Treatment of large ischial ulcers communicating with the hip joint with proximal femoral resection and reconstruction with a combined vastus lateralis, vastus intermedius and rectus femoris musculocutaneous flap. J Plast Reconstr Aesthetic Surg. 62(11):1497–1502
10.
Simón E, Pérez-García A, Lorca-García C, Safont J (2013) Sensate vastus lateralis muscle flap for reconstruction of complex ischial sore. Microsurgery. 33(2):164–165PubMed
11.
Lin H, Hou C, Xu Z, Chen A (2010) Treatment of ischial pressure sores with double adipofascial turnover flaps. Ann Plast Surg. 64(1):59–61PubMed
12.
Kim CM, Yun IS, Lee DW, Lew DH, Rah DK, Lee WJ (2014) Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps. Arch Plast Surg. 41(4):387–393PubMedPubMedCentral
13.
Lee S-S, Huang S-H, Chen M-C, Chang K-P, Lai C-S, Lin S-D (2009) Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap. J Plast Reconstr Aesthetic Surg. 62(10):1339–1346
14.
Borgognone A, Anniboletti T, De Vita F, Schirosi M, Palombo P (2010) Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way. Spinal Cord. 48(10):770–773PubMed
15.
Demirseren ME, Ceran C, Aksam B, Demiralp CO (2016) Clinical experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap for the reconstruction of ischial pressure ulcers. Ann Plast Surg. 77(1):93–96PubMed
16.
He J, Xu H, Wang T, Ma S, Dong J (2012) Treatment of complex ischial pressure sores with free partial lateral latissimus dorsi musculocutaneous flaps in paraplegic patients. J Plast Reconstr Aesthetic Surg. 65(5):634–639
17.
Hallock GG (2006) The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg. 56(5):540–542PubMed
18.
19.
Kelahmetoglu O, Van Landuyt K, Yagmur C et al (2017) A simple concept for covering pressure sores: wound edge-based propeller perforator flap. Int Wound J. 14(6):1183–1188PubMed
20.
Meltem Ç, Esra Ç, Hasan F, Ali D (2004) The gluteal perforator-based flap in repair of pressure sores. Br J Plast Surg. 57(4):342–347PubMed
21.
22.
Kim YS, Lew DH, Roh TS, Yoo WM, Lee WJ, Tark KC (2009) Inferior gluteal artery perforator flap: a viable alternative for ischial pressure sores. J Plast Reconstr Aesthetic Surg. 62(10):1347–1354
23.
Unal C, Ozdemir J, Yirmibesoglu O, Yucel E, Agir H (2012) Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage. Ann Plast Surg. 69(1):67–72PubMed
24.
Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 8(5):336–341PubMed
25.
Bertheuil N, Aillet S, Heusse J-L, Tawfik M, Campillo-Gimenez B, Watier E (2014) Ischial pressure ulcers. Ann Plast Surg. 73(6):686–691PubMed
26.
Ahluwalia R, Martin D, Mahoney JL (2010) The operative treatment of pressure wounds: a 10-year experience in flap selection. Int Wound J. 7(2):103–106PubMed
27.
Angrigiani C, Grilli D, Siebert J, Thome C (1995) A new musculocutaneous island flap from the distal thigh for recurrent ischial and perineal pressure sores. Plast Reconstr Surg. 96(4):935–940PubMed
28.
Cope C, Barry P, Hassall M, Barnett R, Richards M, Vandervord J (1995) V-Y Advancement hamstring myocutaneous island flap repair of ischial pressure ulcers. Aust N Z J Surg. 65(6):412–416PubMed
29.
Lin H, Hou C, Chen A, Xu Z (2010) Treatment of ischial pressure sores using a modified gracilis myofasciocutaneous flap. J Reconstr Microsurg. 26(3):153–157PubMed
30.
31.
Rajacic N, Gang RK, Dashti H, Behbehani A (1994) Treatment of ischial pressure sores with an inferior gluteus maximus musculocutaneous island flap: an analysis of 31 flaps. Br J Plast Surg. 47(6):431–434PubMed
32.
33.
34.
Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J (2012) A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg. 130(1):67–77
35.
36.
Santanelli Di Pompeo F, Longo B, Pagnoni M, Laporta R (2015) Sensate anterolateral thigh perforator flap for ischiatic sores reconstruction in meningomyelocele patients. Microsurgery. 35(4):279–283PubMed
Metadata
Title
Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores
Author
Mehmet Altıparmak
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 3/2020
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-019-01599-7

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