Rotational repair of pressure ulcer using double-perforators based flaps: A report of 11 cases

National Pressure Ulcer Advisory Panel (NPUAP) stage 3 and 4 pressure ulcers typically require surgical repair with perforator-based flaps and fasciocutaneous flaps. We designed advancement/rotation flaps based on two different perforators originating from two different mother vessels that covered large pressure ulcers without the need for additional skin grafts for donor sites. In this paper, we describe the surgical technique on the use of the advancement/rotation flaps and report the preliminary results of surgical management of 11 cases of pressure ulcers using advancement/rotation flaps. Six cases received advancement/rotation flaps based on bilateral superior gluteal artery perforators, and two cases received the first advancement/rotation flap based on the profunda femoris and the second flap based on the superior gluteal artery perforator. Surgery was successful in all cases and all flaps were viable. The patients were followed up for a median duration of 12 (rang 6 to 24) months and no recurrence was reported. In conclusion, the advancement/rotation flaps based on two different perforators are feasible and safe for large pressure ulcers and offer an effective alternative surgical technique for repair of large wound beds.