Published online Nov 6, 2023. doi: 10.12998/wjcc.v11.i31.7562
Peer-review started: August 31, 2023
First decision: September 19, 2023
Revised: September 23, 2023
Accepted: October 26, 2023
Article in press: October 26, 2023
Published online: November 6, 2023
Various reconstruction options have been introduced to treat decubitus ulcers. A combined flap that takes advantage of the fasciocutaneous and muscle flaps has been proven to be effective in reconstructing decubitus ulcers in previous studies. However, no studies have measured combined flap thickness. This is the first study to demonstrate the superiority of the combined flap by measuring its thickness using enhanced abdominopelvic computed tomography (APCT).
To evaluate combined flap modality as a useful reconstruction option for decubitus ulcers using measurements obtained through APCT.
Fifteen patients with paraplegia who underwent combined flap surgery for reconstruction of decubitus ulcers between March 2020 and December 2021 were included. The defects in the skin and muscle components were reconstructed separately. The inner gluteus muscle flap was split and manipulated to obliterate dead space. The outer fasciocutaneous flap was transposed to cover the muscle flap and opening of the decubitus ulcer. Subsequently, we performed enhanced APCT at 3 wk and 6 mo postoperatively to measure the flap thickness.
The mean flap thickness was 32.85 ± 8.89 mm at 3 wk postoperatively and 29.27 ± 8.22 mm at 6 mo postoperatively. The flap thickness was maintained without any major complications such as contour deformities or recurrence.
Although there was a significant decrease in flap thickness as measured by APCT, the combined flap provided sufficient padding and maintained its thickness even at 6 mo after reconstruction, suggesting that the combined flap modality may be a useful reconstruction option for patients with paraplegic decubitus ulcers.
Core Tip: In this study, we examined the use of combined fasciocutaneous and gluteus maximus muscle flaps to reconstruct grade IV decubitus ulcers in patients with paraplegia. Radiological evaluation was employed to measure flap thickness, and the combined flap approach was found to provide successful reconstruction, with only minor complications. The study revealed a slight reduction in flap thickness over time; however, adequate coverage was maintained. This combined flap method offers a valuable treatment option for challenging decubitus ulcers in patients with paraplegia, and addresses the issues of flap thickness and recurrence.