The gluteus maximus V-Y advancement flap for reconstruction of extensive soft tissue loss following an advanced sacral pressure ulcer. A case report and mini review

• Published in: International journal of surgery case reports Vol. 73; pp. 15 - 21
• Main Authors: Tchuenkam, Landry W., Titcheu, Flobert, Mbonda, Aimé, Kamto, Trevor, Nwaha, Axel M., Kamla, Igor J., Tochie, Joel Noutakdie
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Pressure ulcer; sacrum; V-Y advancement flap; cpm; m2; Pressure ulcer; g; cm; mmHg; l; Pus; NPUAP; mm3; sacrum; V-Y advancement flap; mg; PIs; bpm; WHO
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.06.060

•Management of the pressure injuries (PIs) consisted of sequentially performed actions: wound debridement, cleansing, dressing and wound coverage.•Wound coverage should be done once the local infection is treated, the debridement is done and the budding is obtained.•Several processes can be performed for wound coverage: second intention healing, direct wound closure, skin grafting and fasciocutaneous flap or myocutaneous flap.•The main operative steps concerning V–Y flap surgery are: flap drawing, flap edge incision, dissection follow by the lifting and transposition of the flap on the recipient area, completed by fixation of the flap in the recipient area and closure of the donor area under suction drains. The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative. We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V–Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter. PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.