title: Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage.
abstract: BACKGROUND
  Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites.
  
  
  METHODS
  Between September 2005 and 2009, 11 patients (9 male, 2 female) with ischial sores were operated by using IGA and posterior thigh perforator flaps. The data of patients included age, sex, cause of paraplegia, flap size, perforator of flap, previous surgeries, recurrences, complications, and postoperative follow-up.
  
  
  RESULTS
  Nine IGA and 5 posterior thigh perforator flaps were used. Six patients presented with recurrent lesions, 5 patients were operated for sacral and contralateral ischial pressure sores previously. In 2 patients, IGA and posterior thigh perforator flaps were used in combination. Patients were followed for an average of 34.3 months. In 2 recurrent cases, readvancement of IGA perforator flap and gluteus maximus myocutaneous flap were treatment of choice.
  
  
  CONCLUSIONS
  Treatment of patients with recurrent lesions or multiple pressure sores is challenging because of limited available flap donor sites. In this study, posterior thigh perforator flaps were preferred in patients in whom the previous donor site was the gluteal region. IGA perforator flaps were the treatment of choice in patients for whom posterior thigh region was previously used. Alternately, preserved perforators of previous conventional myocutaneous flaps enabled us to use these perforators in recurrences.
authors.affiliation: Plastic Reconstructive and Aesthetic Surgery Department, Kocaeli University Medical Faculty, Izmit, Turkey. cigdem_unal_75@hotmail.com
authors.forename: Cigdem
authors.initials: C
authors.lastname: Unal
authors.forename: Jale
authors.initials: J
authors.lastname: Ozdemir
authors.forename: Oktay
authors.initials: O
authors.lastname: Yirmibesoglu
authors.forename: Ergin
authors.initials: E
authors.lastname: Yucel
authors.forename: Hakan
authors.initials: H
authors.lastname: Agir
mesh_terms: D000328:Adult; D002081:Buttocks / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications; D003668:Pressure Ulcer / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply; D013848:Thigh / Q000098:blood supply; D016896:Treatment Outcome