[Inguinal island flap for covering trochanteric bedsores]

Trochanteric bedsores are a serious condition because of the danger of osteoarthritis of the coxofemoral joint, which is a source of septicemia, and also because of the difficulty of covering them with skin owing to the mobility of the bone and the absence of skin laxity in the area. The authors suggest a new technique of closure after local preparation providing a clean "surgical" defect. They use a groin island flap raised in the Japanese "retrograde" manner (i.e. laterally to medially). This technique is of course the fruit of the authors' experience of the microsurgery. The distal portion of the flap is drawn, corresponding to the size of the defect (round shape). The proximal portion contains the vessels surrounded by subcutaneous and protected by a de-epithelialized triangle of skin with a distal base. The flap is passed through a subcutaneous tunnel between the femoral trigone and the trochanteric area to be covered. The donor site is closed by approximation of the edges after they have been undermined. The authors discuss the others possible surgical managements: 1) local flaps (transposition flap, Z plasties, are unsuitable; 2) the double S-rotation flap had the drawback of creating a large undermined area and leaving a scar on the trochanteric region; 3) simple GER-type muscle flaps are not advisable because the transposed muscle always indergoes a fibrous involution so that the graft provides insufficient protection; 4) myocutaneous flaps, and especially fascia lata myocutaneous flap, offer better indication, because of muscle only acts as a vascular pedicle for the skin flap. The only drawback is the relative defect resulting from raising the flap. The authors conclude that the groin island flap offers the following advantages; a skin material which is more than efficient; ideal vascularization; perfect corverage without undue tension of the trochanteric surface; an interesting training for the plastic surgeon performing microsurgical reconstruction.