In the ambulatory patient, segmental harvesting of the muscle can be performed to optimize the patient's functional status. An alternative source of tissue is a fasciocutaneous flap obtained from the lower back. 69 year old non- ambulatory man with stage IV sacral pressure sore. Bilateral gluteus maximus myocutaneous advancement flaps. 3-weeks after surgery, wound completely healed at 6 month followup.
Ischial defects are very amenable to local myocutaneous flap reconstruction.
The gluteus maximus flap can be used for this purpose also. Alternatives include the gracilis myocutaneous flap and the posterior thigh fasciocutaneous flap. Ulcer being completely excised. Wound completely healed. Trochanteric pressure sores almost always require more than primary repair.