1. Modified inferior gluteal artery perforator-based hatchet-shaped flap for reconstruction of trochanteric pressure sores 改良下臀動脈穿通枝皮瓣 用於重建股骨大轉子褥瘡
陳俊宇 曾元生
三軍總醫院外科部 整形外科

2. Case report A 79-year-old man Type 2 diabetes mellitus
End-stage renal disease
Hypertension
Parkinsonism
Chronic obstructive pulmonary disease
Inferior wall myocardial infarction after coronary artery bypass grafting

3. Recurrent stage IV left trochanteric pressure sore

4. After debridement, an 88 cm defect was created

5. Inferior Gluteal Artery Perforator-based hatchet-shaped flap

6. The flap was designed with a diameter 1
The flap was designed with a diameter 1.5–2 times the longitudinal diameter of the defect and included more than one perforator
Subfascial flap dissection to explore the selected inferior gluteal artery perforators
The vessel was dissected out to approximately 0.5 cm in length rather than by skeletonization of the perforator.

7. The IGAPs was detected by handle Doppler probe.

10. Discussion Treatment of trochanteric pressure sores
Local flaps are the first choice
Musculocutaneous, fasciocutaneous, or perforator flaps.
Rotation, advancement, or island flaps
The most commonly used flaps for trochanteric sores
Tensor Fascia Lata (TFL) flaps
Pedicled anterolateral thigh (ALT) flaps

11. Disadvantages of Traditional TFL flaps
Wound coverage with the most distal and poorly vascularized portion of the flap
Dog-ear deformity in the lateral thigh
Primary repair of the donor area usually requires closure under extensive tension

12. Disadvantages of Pedicled ALT flaps
Closure of the donor site generally requires skin grafting if the wound diameter is > 7 cm
Lower recurrence rate, but needed a longer operative time than hatchet-shaped TFL flaps
ALT flaps are not suitable for critically ill patients

13. Modified hatchet-shaped technique
Combined the advantage of
Fasciocutaneous flaps
More durable and less susceptible to ischemia than myocutaneous flaps
Perforator flaps
Reliable wound coverage
Without sacrificing muscle tissue

14. Obliterate the cavity without tension
Skin flaps measuring about 1110 cm could be well vascularized by one perforator
Major advantages over the V–Y advancement technique with less blood loss, shorter operating times, safer circulation

15. Insert the most proximal and well-vascularized portion of the flap into the bony defect area
Decrease complication rates compared with true perforator flap techniques

16. Advantages of a flap derived from the gluteal region
Minimizes donor site morbidity
Sparing the gluteal muscle
Primary closure of the donor site
Avoids maximal pressure zones over bony prominences

17. Conclusion The modified IGAP flap procedure Simple and fast operation
Avoids sacrificing muscle
Improves the safety of circulation
Closure of the donor site is simpler
It serve as an acceptable alternative for the surgical repair of trochanteric pressure sores.