Wide posterior gluteal-thigh propeller flap for reconstruction of perineal defects

The Value of a Modified Posterior Thigh Flap with Z-Plasty for Reconstruction of Ischial Tuberosity Pressure Ulcers: A Retrospective Single Center Analysis

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.

Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm

BACKGROUND

Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies.

METHODS

Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated.

RESULTS

In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm² (range, 8-900 cm² ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results.

CONCLUSIONS

Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects.

Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta-analysis

BACKGROUND

Perforator propeller flaps (PPFs) have been widely used due to their numerous advantages; however, they were also associated with various complications. Herein, we analyzed the risk factors for complications of PPFs used for soft tissue reconstruction after malignant tumor resection.

METHODS

We searched databases for articles on soft tissue reconstruction using PPFs after malignant tumor resection published between January 1991 and April 2021. Studies were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Fixed effects models and relative risks were used for data analysis. Funnel plots and Begg's test were used to evaluate publication bias.

RESULTS

Twenty-six articles met the inclusion criteria. Complications were found in 24.7% of all patients. The four significant risk factors were age equal or older than 60 years (pooled relative risk, 1.83; p = .04), smoking (pooled relative risk, 2.32; p = .03), diabetes (pooled relative risk, 2.59; p = .01) and radiotherapy (pooled relative risk, 2.09; p = .01). Hypertension, defects located in the extremities, flap size equal or greater than 100 cm² , and pedicle rotation equal or greater than 120 degrees were not significant risk factors for complications. No publication bias was found in the included articles.

CONCLUSION

Age equal or older than 60 years, smoking, diabetes and radiotherapy are four risk factors for complications when PPFs are used to reconstruct soft tissue defects resulting from malignant tumor resection.