The Value of a Modified Posterior Thigh Flap with Z-Plasty for Reconstruction of Ischial Tuberosity Pressure Ulcers: A Retrospective Single Center Analysis.
Abstract: Pressure ulcers are a persistent and growing challenge in modern medicine, with prevalence rates ranging from 3.4% to 32.4% globally. Demographic changes suggest an increasing number of patients at risk, emphasizing the need for effective prevention and advanced treatment strategies. These ulcers, particularly stages III and IV, often require surgical intervention due to severe tissue damage. Among the surgical options, the Posterior Thigh Flap has emerged as a reliable fasciocutaneous flap, frequently referred to as a "work-horse flap", for defect coverage in the ischial region. To improve outcomes and minimize recurrences in weight-bearing areas, our clinic combined this flap technique with a Z-plasty modification to achieve redistribution of scar tissue to reduce localized pressure. In this retrospective study, six patients with seven ischial pressure ulcers were treated between 2003 and 2024 using this approach. Following debridement and wound conditioning with negative pressure therapy, defect coverage was performed. The results show clinically acceptable complication rates (42.9%) and a low recurrence rate (14.3%), with recurrences occurring no earlier than 12 months post-treatment. The Z-plasty effectively shifted scar zones away from high-pressure areas, reducing tension and recurrence risk. This study highlights the potential benefits of combining fasciocutaneous flaps with scar management techniques to improve long-term outcomes for ischial pressure ulcers and provides an innovative approach to treating ischial pressure ulcers.
Publication Date: 2025-01-22 PubMed ID: 40003555PubMed Central: PMC11856684DOI: 10.3390/life15020146Google Scholar: Lookup
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- Journal Article
Summary
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The research primarily focuses on investigating the impact of combining the Posterior Thigh Flap surgical technique and Z-plasty modification in treating stages III and IV Ischial Tuberosity Pressure Ulcers. The results of the retrospective study indicate this approach may effectively reduce the risk of complications and relapse in patients.
Context of the Research
- The authors of the paper focus on sthe udy of pressure ulcers which, from a global perspective, present a significant public health issue, manifesting in between 3.4% and 32.4% of the population.
- They underline the increasing requirement for effective treatment strategies and prevention measures due to the predicted increase in the patient population at risk for developing this condition.
Specific Research Scope and Methodology
- The main essence of the research revolves around complex stages III and IV pressure ulcers that generally necessitate surgical intervention.
- The authors propose improvements to the standard procedure of utilising a Posterior Thigh Flap, a dependable surgical method often used to cover defects in the ischial region.
- The innovation of the presented practice lies in the incorporation of Z-plasty modification into the traditional surgical process, aimed at repositioning the scar tissue to decrease localized pressure, hence, preventing relapses.
- The research evaluates the data of six patients suffering from ischial pressure ulcers who were treated with the modified technique between 2003 and 2024.
Key Findings and Conclusion
- The presented approach was evaluated based on the postoperative complication rates, recurrence rates, and time of recurrence.
- The results point to acceptable complication rates (42.9%) and low recurrence rates (14.3%), with no recurrence instances recorded earlier than 12 months following the treatment.
- The Z-plasty modification was deemed efficient in redistributing scar zones away from high-pressure areas, thereby diminishing tension and recurrence risk.
- The authors conclude that combining fasciocutaneous flaps with scar management techniques could pave the way for improved long-term outcomes for patients with ischial pressure ulcers.
Cite This Article
APA
Stumpfe MC, Horch RE, Müller-Seubert W.
(2025).
The Value of a Modified Posterior Thigh Flap with Z-Plasty for Reconstruction of Ischial Tuberosity Pressure Ulcers: A Retrospective Single Center Analysis.
Life (Basel), 15(2), 146.
https://doi.org/10.3390/life15020146 Publication
Researcher Affiliations
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Conflict of Interest Statement
The authors declare no conflicts of interest.
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