Reconstruction of Trochanteric Pressure Ulcers With Pedicled Vastus Lateralis-Anterior Lateral Thigh Flap

Abstract

OBJECTIVES: The trochanteric region is a frequent site for pressure ulcer development. The etiology is due to immobilization and prolonged hospitalization. Loss of the subcutaneous fat layer is another predisposing factor in cachectic patients. For patients with grade 3 to 4 sores with trochanteric major of femur exposition, flap reconstruction is generally needed. Musculocutaneous flaps are preferred to cover exposed bone and fill dead space. Although locoregional flaps such as tensor fascia lata and gluteus maximus muscle flaps have been used for trochanteric ulcers, these involve mandatory muscles for ambulation during rehabilitation. Another disadvantage is donor site complications due to pressure loading. Here, we describe the vastus lateralis-anterolateral thigh flap to decrease donor site morbidity and tension. MATERIALS AND METHODS: Between 2019 and 2021, we treated 9 trochanteric pressure ulcers in 8 patients (mean age of 38 years; range, 27-52 y). Defect sizes ranged from 5 × 5 to 10 × 12 cm. Flap sizes were planned according to exact defect size. Vastus lateralis muscle was retrieved according to dead space size. Donor sites could be closed in 5 patients, but 2 patients required split thickness skin grafts. Patients were hospitalized in lateral decubitus or supine position during follow-up. RESULTS: Mean follow-up time was 10 months (range, 6-18 mo). All flaps survived. One patient developed hematoma at donor site, which was treated with bedside debridement; no recurrence occurred during follow-up. No restrictions or morbidities were encountered during ambulation. CONCLUSIONS: The vastus lateralis-anterolateral thigh musculocutaneous flap provides both the required tissue for dead space filling and for defect closing. Advantages include lower donor site morbidity, perfect match in terms of skin quality and bulk, and protection of major muscles such as gluteus maximus and tensor fascia lata. The technique requires knowledge of quadratus femoris anatomy, which has a short learning curve.