How are trochanteric pressure injuries (pressure ulcers) repaired?

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

Trochanteric pressure injuries are less common and are typically associated with minimal skin loss. Excisional debridement of these injuries in preparation for flap repair involves resection of the entire bursa and greater trochanter of the femur. The first option for reconstruction of trochanteric pressure injuries is the TFL flap, a myocutaneous flap based on the lateral femoral circumflex artery. [167] The TFL is 13 cm long, 3 cm wide, and 2 cm thick, and it originates from the anterior superior iliac spine (ASIS) and the iliac crest and inserts into the iliotibial tract.

The skin paddle is harvested in a width of 10 cm and designed over the muscle along an axis from the ASIS to the lateral tibial condyle (see the image below).

Skin paddle is harvested 10 cm in width and design Skin paddle is harvested 10 cm in width and designed over muscle along axis from anterior superior iliac spine to lateral tibial condyle.

The inferior limit of the cutaneous territory can be extended to 6 cm above the knee and 25-35 cm in length (see the image below). The lateral femoral circumflex artery can be found approximately 6-8 cm inferior to the ASIS. In patients with lumbar lesions, a sensate TFL flap can be designed to include the T12 dermatome by fashioning the flap to include the area 6 cm posterior to the ASIS.

Inferior limit of cutaneous territory can be exten Inferior limit of cutaneous territory can be extended to 6 cm above knee and 25-35 cm in length. Lateral femoral circumflex artery can be found approximately 6-8 cm inferior to anterior superior iliac spine.

Other described modifications of the TFL flap include the retroposition V-Y flap and the bipedicled TFL flap. Other options for trochanteric pressure injury reconstruction include the vastus lateralis myocutaneous flap, the gluteal thigh flap, and the anterior thigh flap.


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