The foot fillet flap for ischial pressure sore reconstruction: A new indication

Introduction: The main cause of ischial pressure sores in paraplegic patients is prolonged sitting without pressure relief. These wounds are subject to recurrence and may need repeated reconstruction with local flaps. When all options are exhausted, the total thigh flap is the last resort. Disarticulation of the hip joint impairs stability even when sitting and causes subsequently very high discomfort. In this manuscript, we describe an alternative to the total thigh flap to avoid hip disarticulation: the foot fillet flap. Materials & Methods: This study was performed on four patients at the department of Plastic & Reconstructive Surgery of the Ghent University Hospital, Belgium. Inclusion criteria were the following: paraplegic patients affected by recurrent pressure sores, exhaustion of all local options and adequate vascular status of the lower extremities. Results: All patients were kept in an air-fluidized bed for two weeks and progressed well during their post-operative course. Healing time varied from 12 to 29 days and suction drains were removed after 15 days as in any standard pressure sore flap. Hospital stay varied from 18 to 42 days. Conclusion: The pedicled foot fillet flap is a valuable alternative to the total thigh flap. Coverage of large, recurrent, pressure sores in the ischial, trochanteric or sacral region is ideal due to the thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue and underlying muscles provided by the sole of the foot. Furthermore, coxofemoral disarticulation, mandatory in a total thigh flap, that leads to instability while sitting, is avoided.