The "duck" modification of the tensor fascia lata flap

Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure.