The Foot Fillet Flap for Ischial Pressure Sore Reconstruction: A New Indication

Publication date: Available online 2 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): K. Peters, B. Colebunders, S. Brondeel, S. D'Arpa, S. Monstrey

Abstract

Introduction

The main cause of ischial pressure sores in paraplegic patients is prolonged sitting without pressure relief. These wounds are subject to recurrence and may need repeated reconstruction with local flaps. When all options are exhausted, the total thigh flap is the last resort. Disarticulation of the hip joint impairs stability even when sitting and causes subsequently very high discomfort. In this manuscript, we describe an alternative to the total thigh flap to avoid hip disarticulation: the foot fillet flap.

Materials & Methods

This study was performed on four patients at the department of Plastic & Reconstructive Surgery of the University Hospital Ghent, Belgium. Inclusion criteria were the following: paraplegic patients affected by recurrent pressure sores, exhaustion of all local options and satisfying vascular status of the lower extremities.

Results

All patients were kept in an air-fluidized bed for two weeks and progressed well during their post-operative course. Healing time varied from 12 to 29 days and suction drains were removed when they collected less then 20cc per 24h. Hospital stay varied from 18 to 42 days.

Conclusion

The pedicled foot fillet flap is a valuable alternative to the total thigh flap. The covering of pressure sores in the ischial, trochanteric or sacral region is ideal due to the thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue and underlying muscles provided by the sole of the foot. Furthermore, coxofemoral disarticulation, leading to instability while sitting, is avoided.