title: 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.
abstract: BACKGROUND
  The reconstruction of ischial pressure ulcers is problematic because of the distinctive anatomical properties of the region and high recurrence rates. To date, no single technique has been proven to be effective in reducing recurrence of the ulcers. We present our experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap and discuss the long-term results.
  
  
  METHODS
  A retrospective clinical analysis of 15 patients with grade 4 ischial pressure ulcers reconstructed with biceps femoris muscle turnover flaps and laterally based posterior thigh fasciocutaneous hatchet flaps was carried out between January 2010 and January 2013. Debridement and reconstruction of the ulcers were accomplished in a single stage. The posterior thigh fasciocutaneous flap was elevated in a hatchet style. The long and/or short head of the biceps femoris muscle were dissected from their insertions, turned over on their major pedicles, and their distal portions were used to obliterate the cavitary defect. The skin defect over the muscles was covered by the fasciocutaneous hatchet flap. The average age of the patients was 42.6 years and the mean follow-up time was 27.2 months.
  
  
  RESULTS
  Three patients had the following early postoperative complications: hematoma, suture dehiscence, and the necrosis of the short head of biceps muscle. Only 1 patient had a recurrent ulcer 15 months after surgery, which was treated with debridement and the readvancement of the fasciocutaneous flap. The overall recurrence rate was 6.6%.
  
  
  CONCLUSIONS
  The biceps femoris muscle turnover flap combined with the posterior thigh fasciocutaneous hatchet flap is a worthwhile option to consider for the reconstruction of ischial pressure ulcers and this technique produces favorable results in terms of the lack of recurrence and complications. The use of the muscle and fasciocutaneous tissue as 2 different flaps, which have different roles in the early and late postoperative period, reduces the recurrence rate.
authors: From the Yildirim Beyazit University School of Medicine, Ankara Atatürk Research and Training Hospital, Ankara, Turkey.
authors: Mustafa Erol
authors: ME
authors: Demirseren
authors: Candemir
authors: C
authors: Ceran
authors: Berrak
authors: B
authors: Aksam
authors: Cemil Ozerk
authors: CO
authors: Demiralp
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D000070633:Hamstring Muscles / Q000601:surgery*; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery*; D016896:Treatment Outcome