Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series
Objective Most paraplegic patients with complicated trochanter sores or ischial sores present with lower limb muscle atrophy. Therefore, in patients who have undergone Girdlestone arthroplasty, filling the dead space and replacing the volume defect through an appropriate surgical technique is extrem...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.13846 |
| _version_ | 1797666349264142336 |
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| author | Hyun Jung Ryoo Ji Hwan Park Dong Yeon Kim |
| author_facet | Hyun Jung Ryoo Ji Hwan Park Dong Yeon Kim |
| author_sort | Hyun Jung Ryoo |
| collection | DOAJ |
| description | Objective Most paraplegic patients with complicated trochanter sores or ischial sores present with lower limb muscle atrophy. Therefore, in patients who have undergone Girdlestone arthroplasty, filling the dead space and replacing the volume defect through an appropriate surgical technique is extremely challenging. This study presents a case series of vastus lateralis and vastus intermedius myocutaneous flap reconstruction after extended proximal femoral osteotomy in paraplegic patients. The aim of study is to investigate (i) whether sufficient volume replacement was achieved, (ii) whether muscle volume was maintained during long‐term follow‐up, and (iii) the presence of donor site morbidity. Method A retrospective review was conducted with eight patients who underwent this method from March 2017 to December 2021. A total of nine flaps was elevated, and the defect was successfully reconstructed without dead space. Computed tomography was performed to identify the changes in thickness and volume of the muscle portion. The Wilcoxon signed‐rank test was performed to assess the significance of the differences in muscle thickness between pre‐ and post‐measurements. Results After surgery, all patients healed within 1 month; three patients experienced minor complications. The average follow‐up period was 14.5 months, during which only one patient with an ischial pressure ulcer developed wound disruption and recurrence. The average thickness of the rotated muscle was 51.95 mm at 2 to 4 weeks postoperatively and 53.07 mm at 6 months postoperatively (𝑝 = 0.071). Conclusion All nine cases healed well without major complications. When comparing the volume of the rotated muscle on radiological examinations before and after surgery, no significant differences were observed. Our modified Girdlestone resection technique provides a simple and reliable method for reconstructing complex trochanteric or ischial sores in paraplegic patients. It ensures anatomical consistency, ample volume, and structural stability by leaving the rectus femoris (RF) in place. Careful tension management is required when using this flap in the ischial area. |
| first_indexed | 2024-03-11T19:58:20Z |
| format | Article |
| id | doaj.art-3bdc083558a84d42bbcde715338bae8b |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-11T19:58:20Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-3bdc083558a84d42bbcde715338bae8b2023-10-04T14:23:12ZengWileyOrthopaedic Surgery1757-78531757-78612023-10-0115102612262010.1111/os.13846Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case SeriesHyun Jung Ryoo0Ji Hwan Park1Dong Yeon Kim2Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine The Catholic University of Korea Seoul Republic of KoreaDepartment of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine The Catholic University of Korea Seoul Republic of KoreaDepartment of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine The Catholic University of Korea Seoul Republic of KoreaObjective Most paraplegic patients with complicated trochanter sores or ischial sores present with lower limb muscle atrophy. Therefore, in patients who have undergone Girdlestone arthroplasty, filling the dead space and replacing the volume defect through an appropriate surgical technique is extremely challenging. This study presents a case series of vastus lateralis and vastus intermedius myocutaneous flap reconstruction after extended proximal femoral osteotomy in paraplegic patients. The aim of study is to investigate (i) whether sufficient volume replacement was achieved, (ii) whether muscle volume was maintained during long‐term follow‐up, and (iii) the presence of donor site morbidity. Method A retrospective review was conducted with eight patients who underwent this method from March 2017 to December 2021. A total of nine flaps was elevated, and the defect was successfully reconstructed without dead space. Computed tomography was performed to identify the changes in thickness and volume of the muscle portion. The Wilcoxon signed‐rank test was performed to assess the significance of the differences in muscle thickness between pre‐ and post‐measurements. Results After surgery, all patients healed within 1 month; three patients experienced minor complications. The average follow‐up period was 14.5 months, during which only one patient with an ischial pressure ulcer developed wound disruption and recurrence. The average thickness of the rotated muscle was 51.95 mm at 2 to 4 weeks postoperatively and 53.07 mm at 6 months postoperatively (𝑝 = 0.071). Conclusion All nine cases healed well without major complications. When comparing the volume of the rotated muscle on radiological examinations before and after surgery, no significant differences were observed. Our modified Girdlestone resection technique provides a simple and reliable method for reconstructing complex trochanteric or ischial sores in paraplegic patients. It ensures anatomical consistency, ample volume, and structural stability by leaving the rectus femoris (RF) in place. Careful tension management is required when using this flap in the ischial area.https://doi.org/10.1111/os.13846Flap ReconstructionGirdlestone ArthroplastyIschial SorePressure SoreTrochanteric SoreVastus Intermedius |
| spellingShingle | Hyun Jung Ryoo Ji Hwan Park Dong Yeon Kim Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series Orthopaedic Surgery Flap Reconstruction Girdlestone Arthroplasty Ischial Sore Pressure Sore Trochanteric Sore Vastus Intermedius |
| title | Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series |
| title_full | Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series |
| title_fullStr | Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series |
| title_full_unstemmed | Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series |
| title_short | Vastus Lateralis and Vastus Intermedius Myocutaneous Flap Reconstruction for Complicated Trochanteric and Ischial Pressure Sores with Extended Girdlestone Resection: A Case Series |
| title_sort | vastus lateralis and vastus intermedius myocutaneous flap reconstruction for complicated trochanteric and ischial pressure sores with extended girdlestone resection a case series |
| topic | Flap Reconstruction Girdlestone Arthroplasty Ischial Sore Pressure Sore Trochanteric Sore Vastus Intermedius |
| url | https://doi.org/10.1111/os.13846 |
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