Reconstruction of Ischial Soft Tissue Defects using Adductor Magnus Perforator Island Flap

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially in paraplegic patients. Although various muscle, musculocutaneous and fasciocuta- neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still controversial which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 to January 2008, the adductor magnus perforator island flap were used for resurfacing of the ischial soft tissue defects in a series of 6 patients(4 male and 2 female). Ages ranged from 26 to 67 years(mean, 47.5 years), and follow-up period from 13 to 26 months(mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18cm in length and 7 to 9cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split-thickness skin graft. Average thickness of the flap was 0.94cm, which was more thicker than other perforator flaps. Long term follow- up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap as a good and suitable option for coverage of the ischial soft tissue defect.