A NEW MUSCULOCUTANEOUS ISLAND FLAP FROM THE DISTAL THIGH FOR RECURRENT ISCHIAL AND PERINEAL PRESSURE SORES

In the paraplegic patient who has had previous surgeries for pressure sores, local tissue is frequently unavailable for further use. The pos terolateral aspect of the thigh, however, is almost always available a nd provides an excellent reconstructive alternative for this difficult problem. In 1983, Baek described the skin territory supplied by the t hird perforator of the profunda femoris artery. A musculocutaneous fla p can be raised consisting of the same skin territory and a portion of the biceps femoris muscle (short head) through which the third perfor ator courses; In addition, the distal part of the vastus lateralis mus cle, which is supplied by a muscular branch of the same perforator, ca n be included in the flap. The flap is elevated as an island based on the profunda femoris artery and accompanying venae comitantes. A subst antial soft-tissue mass can be transposed easily to the perineum. Stan dard latex injection techniques were used in 12 fresh cadaver dissecti ons prior to use of this flap in 16 clinical cases. Selective india in k injections into the third perforator of the profunda femoris artery in 6 cadavers confirmed the perfusion of the overlying skin territory. Recurrent ischial and perineal wounds were closed successfully with t his musculocutaneous flap in all 16 clinical cases.