Reconstructing ‘dual-defect’ pressure sores in spinal patients

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Ramin Shayan
Aoife Margaret Hurley
Derek Neoh
Dr Stephen Flood
Michael Weymouth


Pressure ulcer, myocutaneous flap, spinal injuries, anterolateral thigh flap


Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.
Methods: Eleven consecutive patients with concurrent pressure sores (> grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded.
Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded.
Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

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1 Raghavan P, Raza WA, Ahmed YS, Chamberlain MA. Prevalence of pressure sores in a community sample of spinal injury patients. Clin Rehabil. 2016;17(8):879–84. PMid:14682560.
2 Australian Institute of Health and Welfare, Norton L. Spinal cord injury, Australia 2007–08 [web report]. Canberra: Australian Government [Updated 25 Oct 2017. Cited 28 May 2019]. (10 March 2010). . Available from:
3 Jakubietz R, Jakubietz D, Zahn R, Schmidt K, Meffert R, Jakubietz M. Reconstruction of pressure sores with perforator-based propeller flaps. J Reconstr Microsurg. 2010;27(3):195–98. PMid:21184385.
4 Kua EHJ, Wong CH, Ng SW, Tan KC. The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers. J Plast Reconstr Aes. 2011;64(1):e21–23. PMid:20851067.
5 Wang CH, Chen SY, Fu JP, Dai NT, Chen SL, Chen TM, Chen SG. Reconstruction of trochanteric pressure sores with pedicled anterolateral thigh myocutaneous flaps. J Plast Reconstr Aes. 2011;64(5):671–76. PMid:20884307
6 Lee JT, Cheng LF, Lin CM, Wang CH, Huang CC, Chien SH. A new technique of transferring island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of recurrent ischial pressure sores. J Plast Reconstr Aes. 2007;60(9):1060–66. PMid:17493884.
7 Zhou CMZSZ, Liu MZ. Anatomy of the anterolateral thigh flap. Chin J Appl Annat. 2015;1:97.
8 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Brit J Plast Surg. 1984;37(2):149–59.
9 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219–26; discussion 2227–30.
10 Mathes SJ, Nahai F. Clinical applications for muscle and musculocutaneous flaps. St Louis, MO, USA: The CV Mosby Company, 1982.
11 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Brit J Plast Surg. 1984;37(2):149–59.
12 Chen HC, Tang YB. Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg. 2003;30(3):383–401.
13 Tzeng YS, Yu CC, Chou TD, Chen TM, Chen SG. Proximal pedicled anterolateral thigh flap for reconstruction of trochanteric defect. Ann Plast Surg. 2008;61(1):79–82. PMid:18580155.
14 Jang HJ, Park J, Shin H-I. Length of hospital stay in patients with spinal cord injury. Ann Rehabil Med. 2011;35(6):798–806. PMid:22506208 PMCid:PMC3309389.