What is the most common site of pressure injuries (pressure ulcers) in individuals with paraplegia?

Updated: Mar 26, 2020
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
  • Print
Answer

The ischial location is the most common site of pressure injury in individuals with paraplegia. In the course of excisional débridement in preparation for flap repair of an ischial wound, aggressive resection of the ischial tuberosity may raise the risk of a contralateral ischial pressure injury from increased contralateral pressure. Bilateral ischiectomy increases pressure on the perineum and thus increases the risk of perineal pressure injury.

Recurrence of the pressure injury is common in the ischial location. [163] Therefore, the first option for reconstruction of ischial wounds is the gluteal thigh rotation flap, which does not preclude the future use of the inferior portion of the gluteus maximus muscle. [164, 165]

The gluteal thigh rotation flap is an axial flap based on the inferior gluteal artery. Both the biceps femoris flap and the hamstring myocutaneous flap transect the inferior gluteal artery. With the gluteal thigh flap, a superiorly based flap is elevated, with its axis being the inferior gluteal artery located between the greater trochanter and the ischial tuberosity (see the image below).

With gluteal thigh flap, superiorly based flap is With gluteal thigh flap, superiorly based flap is elevated, with inferior gluteal artery located between greater trochanter and ischial tuberosity as its axis.

The gluteal thigh rotation flap is raised as a fasciocutaneous flap superiorly to the gluteal crease (see the image below).

Gluteal thigh rotation flap is raised as fasciocut Gluteal thigh rotation flap is raised as fasciocutaneous flap superiorly to gluteal crease.

The gluteal thigh flap may be raised to include the inferior portion of the gluteus maximus. This increases the arc of rotation and allows the flap to be used to reconstruct sacral defects (see the image below). [164]

 

Gluteal thigh flap may be raised to include inferi Gluteal thigh flap may be raised to include inferior portion of gluteus maximus, which increases arc of rotation to allow flap also to be used to reconstruct sacral defects.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!