Use of the biceps femoris following failed inferior gluteal flap transfer. Case report.
Considering the high recurrence rate of pressure ulceration in paraplegic patients, flap procedures to reconstruct a defect should not be at the expense of another possible future flap. The posterior thigh fasciocutaneous flap is useful for the coverage of ischial and trochanteric pressure sores; the biceps femoris musculocutaneous flap is a useful choice for deep ischial defects. However, the cutaneous portions of these two flaps is nearly identical. The previous transfer of the biceps flap excludes the further use of the posterior thigh flap. In contrast, use of the posterior thigh flap still permits the employment of a biceps V-Y advancement flap. Even if the donor site of the previous posterior thigh flap must be skin-grafted, the graft will remain viable on its muscular bed and function as the cutaneous portion of the flap; thus stable coverage is provided, despite previous use of 'first line' flaps. We demonstrate how careful planning of the stages of flap procedures can allow the most economic use of donor areas in this difficult patient group.
Thomas
W O
WO
Division of Plastic and Reconstructive Surgery, University of South Alabama Medical School, Mobile 36693.
Stark
G B
GB
Basadre
J O
JO
Parry
S W
SW
D000328:Adult; D006801:Humans; D008297:Male; D009132:Muscles; D010264:Paraplegia / Q000150:complications; D011183:Postoperative Complications; D003668:Pressure Ulcer / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods*; D014948:Wounds, Gunshot / Q000150:complications