V-Y ADVANCEMENT HAMSTRING MYOCUTANEOUS ISLAND FLAP REPAIR OF ISCHIAL PRESSURE ULCERS

Thirty-seven ischial pressure ulcers were repaired in 27 patients (eig ht quadriplegic, 19 paraplegic) between 1988-1993 using the V-Y advanc ement hamstring myocutaneous island flap. Twenty-one ulcers (57%) aros e de novo and 16 were recurrent, with five patients having bilateral u lcers. The average duration of the ulcer was 5 months (range 1-30). Al l ulcers extended through the deep fascia (clinical grade IV), with th e average diameter being 4.7 cm (range 2-10). There were four major fl ap complications (11%). All but one of the ulcers healed at discharge (97%). Mean follow up was 20 months (range 5-54) in 21 patients (78%), with six patients being lost to follow up. Seven of the 21 (33%) pati ents developed recurrent ulcers, with four of these having flap re-adv ancement with successful healing, and one patient having two re-advanc ements. Overall, 18 of the 21 (86%) patients with follow up had healed ulcers at time of follow up. The V-Y advancement hamstring myocutaneo us island flap is versatile, reliable, easy to perform, has few compli cations, and can be re-advanced in the event of recurrence.