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Weber et al. Pressure ulcer coverage with contralateral gracilis

significant challenge for spinal injury patients. Care 3. Gunnewicht BR. Pressure sores in patients with acute spinal cord
must be taken to design muscle, myocutaneous, and injury. J Wound Care 1995;4:452-4.
fasciocutaneous flaps wisely, to plan for the possibility 4. Bamba R, Madden JJ, Hoffman AN, Kim JS, Thayer WP, Nanney
of additional flap coverage in the future. Before LB, Spear ME. Flap reconstruction for pressure ulcers: an outcomes
analysis. Plast Reconstr Surg Glob Open 2017;5:e1187.
committing to a hip disarticulation and total thigh flap 5. Keys KA, Daniali LN, Warner KJ, Mathes DW. Multivariate
when all local tissue has been used for prior ulcer predictors of failure after flap coverage of pressure ulcers. Plast
coverage, consider flaps from the contralateral lower Reconstr Surg 2010;125:1725-34.
extremity, including the gracilis muscle, which can be 6. Chiu YJ, Liao WC, Wang TH, Shih YC, Ma H, Lin CH, Wu SH, Perng
combined with re-advancement or re-rotation of local CK. A retrospective study: multivariate logistic regression analysis of
flaps. outcomes after pressure sores reconstruction with fasciocutaneous,
myocutaneous, and perforator flaps. J Plast Reconstr Aesthet Surg
2017;70:1038-43.
DECLARATIONS 7. Rubayi S, Chandrasekhar BS. Trunk, abdomen, and pressure sore
reconstruction. Plast Reconstr Surg 2011;128:e201-15.
Authors’ contributions 8. Rubayi S. Reconstructive plastic surgery of pressure ulcers. New
Editorial review and offered clinical advice pertaining York: Springer; 2015.
to literature: S. Rubayi 9. Cheng PTY, Adams BM, Chunilal A. Modified total thigh
Researched related literature and corrected article musculocutaneous flap: ‘operation of last resort’ for massive pressure
ulcers. J Plast Reconstr Aesthet Surg 2014;67:260-3.
grammer: E. Weber 10. Berger SR, Rubayi S, Griffin AC. Closure of multiple pressure sores
with split total thigh flap. Ann Plast Surg 1994;33:548-51.
Financial support and sponsorship 11. Yusmido YA, Hisamud-Din N, Mazian M. Elective proximal lower
None. limb amputation in spinal cord injury patients with chronic pressure
ulcers: improve quality of life, function, and shorten hospital stay. Eur
J Phys Rehabil Med 2014;50:557-60.
Conflicts of interest 12. Patel AC, Kuzon WM Jr. Coverage of an ischial pressure ulcer with
There are no conflicts of interest. an interpolated contralateral posterior thigh fasciocutaneous flap. Br J
Plast Surg 2001;54:547-9.
Patient consent 13. Kierney PC, Cardenas DD, Engrav LH, Grant JH, Rand RP. Limb-
Patient signed consent for photography during surgery salvage in reconstruction of recalcitrant pressure sores using the
inferiorly based rectus abdominis myocutaneous flap. Plast Reconstr
and after surgery. Surg 1998;102:111-6.
14. Lee SS, Huang SH, Chen MC, Chang KP, Lai CS, Lin SD.
Ethics approval Management of recurrent ischial pressure sore with gracilis muscle
Ethical committee approved the case study. flap and V-Y profunda femoris artery perforator-based flap. J Plast
Reconstr Aesthet Surg 2009;62:1339-46.
15. Evans GR, Lewis VL Jr, Manson PN, Loomis M, Vander Kolk CA.
REFERENCES Hip joint communication with pressure sore: the refractory wound and
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the development and recurrence of pressure ulcers in people with 16. Rubayi S, Gabbay J, Kruger E, Ruhge K. The modified Girdlestone
spinal cord injuries. Spinal Cord 2013;51:522-7. procedure with muscle flap for management of pressure ulcers and
2. Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive heterotopic ossification of the hip region in spinal injury patients: a 15-
management of pressure ulcers in spinal cord injury: current concepts year review with long-term follow-up. Ann Plast Surg 2016;77:645-
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194 Plastic and Aesthetic Research ¦ Volume 4 ¦ October 31, 2017