Abstract
Background: The selection of reconstructive procedures for pressure ulcers varies according to the anatomical site and institutional experience. This study aimed to describe the current institutional trends in flap selection for pressure ulcer reconstruction.
Methods: We retrospectively reviewed the records of 74 residents from our department who submitted ten representative cases for the board certification examination of the Japan Society of Plastic and Reconstructive Surgery between 1997 and 2025. The data included the anatomical regions of pressure ulcers and the reconstructive procedures employed.
Results: Of the 74 residents, 63 included one or two cases of pressure ulcers. A total of 39 sacral, 23 ischial, and 13 trochanteric ulcers were reconstructed. Perforator-based fasciocutaneous flaps were predominantly used for sacral ulcers (n = 38), with posterior thigh flaps used in one. Posterior thigh flaps (n = 21) and hamstring myocutaneous flaps (n = 2) were used for ischial ulcers. Trochanteric ulcers were reconstructed using tensor fascia lata myocutaneous flaps (n = 11) and posterior thigh flaps (n = 2). Combined reconstructions were performed in two cases: one involved the simultaneous use of a perforator-based flap for a sacral ulcer and a posterior thigh flap for an ischial ulcer, while the other involved bilateral posterior thigh flaps for sacral and bilateral ischial ulcers.
Conclusions: Perforator-based fasciocutaneous flaps were the most common choice for sacral ulcers, posterior thigh flaps for ischial ulcers, and tensor fascia lata flaps for trochanteric ulcers, reflecting anatomical suitability and evolving surgical practices.
