Musculocutaneous Pedicled Anterolateral Thigh Flap for Reconstruction of Stage IV Trochanteric Pressure Ulcers: Experience in Chronic and Acute Compression Injuries

TL;DR

This paper presents a successful surgical approach using a specific thigh flap to treat severe trochanteric pressure ulcers, showing no recurrence over long-term follow-up.

Contribution

Demonstrates the effectiveness of musculocutaneous pedicled ALT flaps for Stage IV trochanteric pressure ulcers, including acute cases from earthquakes.

Findings

No flap necrosis or recurrence was observed in eight patients over a mean follow-up of 42.4 months.

Minor complications occurred in two cases, but no major flap or donor-site issues were reported.

The flap provided durable coverage for both chronic and acute trochanteric pressure ulcers.

Abstract

Background/Objectives: Trochanteric pressure ulcers represent a challenging reconstructive problem due to their depth, frequent infection, and tendency for recurrence. Durable coverage with well-vascularized tissue capable of effective dead-space management is essential for long-term stability. The pedicled musculocutaneous anterolateral thigh (ALT) flap offers substantial soft-tissue volume with reliable regional vascularity. Methods: A retrospective review was performed of consecutive patients with Stage IV trochanteric pressure ulcers who underwent reconstruction using musculocutaneous pedicled island ALT flaps between January 2020 and August 2023. Ulcers were classified according to the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance International Guidelines. Patients with a minimum follow-up of 24 months were included. Demographic characteristics, ulcer etiology, prior flap history, comorbidities, flap dimensions, postoperative complications, and recurrence rates were analyzed. Results: Eight patients (4 males, 4 females; mean age 46.4 years, range 35–63) were included. Six ulcers (75%) were related to prolonged immobilization, and two (25%) developed following entrapment during the 2023 Kahramanmaraş earthquake. All donor sites were closed primarily. Minor recipient-site complications, including seroma and limited suture dehiscence, occurred in two cases. No partial or total flap necrosis was observed. During a mean follow-up of 42.4 months (minimum 24 months), no recurrence occurred. Conclusions: Musculocutaneous pedicled ALT flaps incorporating a substantial portion of the vastus lateralis muscle allowed effective dead-space obliteration and durable soft-tissue coverage in Stage IV trochanteric pressure ulcers. Primary donor-site closure was achievable without major morbidity. These findings support the use of the pedicled ALT flap as a consistent regional option in complex trochanteric defects, including both chronic immobilization-related and acute compression-related cases.

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