Colour Doppler-Guided Superthin Inferior Gluteal Artery Perforator Flap Elevation for Ischial Pressure Ulcer Reconstruction

Ischial pressure ulcer reconstruction requires durable coverage while preserving local donor options for possible recurrence. The inferior gluteal artery perforator (IGAP) flap is a muscle-sparing option, but superthin elevation requires precise knowledge of the superficial fascial plane and the subcutaneous course of the selected perforator. This technical note describes colour Doppler ultrasonography-guided superficial fascial plane mapping before superthin IGAP flap elevation in a 27-year-old paraplegic patient with a chronic left ischial pressure ulcer who presented in 2025 to a tertiary care university hospital in Muǧla, Turkey. Preoperative high-frequency colour Doppler ultrasonography identified the dominant perforator, measured the relevant fascial intervals and guided a controlled dissection above the superficial fascia. The technique allowed elevation of a thin, pliable flap while preserving deeper gluteal structures and perforator integrity. Colour Doppler-guided fascial mapping may support safer superthin perforator flap elevation in selected pressure ulcer reconstructions.