Inferior Gluteal Myocutaneous Crescent V-Y Pendulum Flap for Closure of Ischial Pressure Sores: A Case Series.

Abstract

Ischial pressure sores present a significant reconstructive challenge due to their high recurrence rates and the need for durable soft-tissue coverage. Various reconstructive techniques exist, but no single approach has emerged as superior. This case series introduces a variation of the gluteal myocutaneous flap, the Inferior Gluteal Myocutaneous Crescent V-Y Pendulum Flap, which provides reliable vascularized tissue while optimizing donor site closure. A retrospective review of 6 patients who underwent reconstruction of ischial pressure sores using the inferior gluteal myocutaneous crescent V-Y pendulum flap between 2010 and 2023 was conducted. Surgical technique involved designing a crescent-shaped skin paddle over a segment of inferior gluteal muscle, which was transposed to fill dead space, with the skin donor site closed in a V-Y fashion. Postoperative care emphasized pressure offloading, physical therapy, and close follow-up to monitor for recurrence and complications. The cohort consisted of 6 patients (4 males, 2 females) with chronic immobility. The mean hospital stay was 21.6 days, and all patients were discharged to rehabilitation facilities for continued pressure offloading. There were no intraoperative or postoperative complications, and no recurrences were observed during the follow-up period, which ranged from 2 to 170 months. The Inferior Gluteal Myocutaneous Crescent V-Y Pendulum Flap offers a reliable reconstructive option for ischial pressure sores by utilizing a robust blood supply, optimizing tension-free closure, and reducing dead space. Careful patient selection, adherence to pressure offloading protocols, and multidisciplinary support are crucial for optimal outcomes.