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Weber et al. Plast Aesthet Res 2017;4:190-4 Plastic and
DOI: 10.20517/2347-9264.2017.73
Aesthetic Research

www.parjournal.net
Case Report Open Access

Complex reconstructive surgery for a

recurrent ischial pressure ulcer with

contralateral muscle

Erin L. Weber , Salah Rubayi
1
1,2
1 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA.
2 Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA.
Correspondence to: Dr. Salah Rubayi, Rancho Los Amigos National Rehabilitation Center, 7601 East Imperial Highway, Downey, CA 90242, USA.
E-mail: srubayi@dhs.lacounty.gov
How to cite this article: Weber EL, Rubayi S. Complex reconstructive surgery for a recurrent ischial pressure ulcer with contralateral muscle. Plast Aesthet
Res 2017;4:190-4.
ABSTRACT
Article history: The management of recurrent pressure ulcers is a frequent problem in patients with spinal
Received: 19 Sep 2017 cord injuries. Many local muscle and fasciocutaneous flaps can be used to cover ulcers of all
Accepted: 18 Oct 2017 sizes. However, when a recurrent pressure ulcer has been repeatedly addressed, the number of
Published: 31 Oct 2017 available flaps becomes quite limited. Contralateral muscles, such as the gracilis, can be used
to cover recurrent ischioperineal ulcers and should be employed before last resort surgeries,
Key words: such as hip disarticulation and the total thigh flap.
Pressure ulcer,
recurrent,
gracilis,
muscle,
contralateral

INTRODUCTION risk of serious infection or sepsis. Therefore, pressure
ulcers, and the constant attention required to prevent
Spinal cord injury predisposes patients to additional them, represent a significant lifetime burden for patients
medical complications. Pressure ulcers are the second with spinal cord injuries.
most common cause of rehospitalization within the first
two decades after injury . The prevalence of pressure The basic tenets of pressure ulcer repair include
[1]
ulcers in patients with spinal cord injury is 25-66% adequate debridement and durable wound coverage with
and 95% of all patients with spinal cord injuries will muscle, myocutaneous or fasciocutaneous flaps. The
develop a pressure ulcer at some point during their gluteus maximus, gracilis, and biceps femoris muscles
lifetime [2,3] . The presence of a pressure ulcer limits are routinely used for the obliteration of ulcer dead space
patient participation in rehabilitation and daily activities, while posterior thigh, tensor fascia lata, and gluteal
requires meticulous wound care, and increases the fasciocutaneous flaps provide durable skin coverage.

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