The fully rotated tensor fasciae latae perforator propeller flap
in reconstruction of trochanteric pressure sores
Ali A. Saalabian
Received: 11 February 2016 /Accepted: 17 May 2016 /Published online: 6 June 2016
Springer-Verlag Berlin Heidelberg 2016
Abstract Reconstruction of trochanteric pressure sores con-
tinues to challenge reconstructive surgeons because recur-
rence is not uncommon and patients typically have undergone
previous surgery. We herein report on the use of a large
adipocutaneous TFLPP rotated for 180° facilitating recon-
struction of a recurring trochanteric decubital ulcer in a 37-
year-old male morbidly obese patient with diabetes mellitus.
The postoperative period showed no adverse events, and no
recurrence was observed to date. The TFLPP is a valuable
option because skin grafts are usually not needed for donor-
site closure, the muscle is spared, and minimal donor-site
morbidity as well as a less bulky appearance is observed.
Level of evidence: Level V, therapeutic study.
Keywords Tensor fasciae latae muscle
Trochanteric pressure sore
Reconstruction of trochanteric pressures sores in bedridden pa-
tients is a well-known surgical problem. Nowadays, numerous
options for reconstruction of pressure sores above the greater
trochanter involving the gluteus maximus, vastus lateralis, or
tensor fasciae latae (TFL) muscle exist. However, recurring
ulcers not only in the trochanteric but also in the ischial and
sacral area are very common in immobilized patients; therefore,
preservation of future donor sites is key. Even though consid-
ered a workhorse in reconstruction of trochanteric decubital
ulcers, the TFL muscle flap has also a few drawbacks in clinical
routine including bulkiness of the flap, gait disturbance, and, in
some cases, the need for split thickness skin grafting .
Hence, the ideal reconstructive modality would provide
well-vascularized pliable tissue for dead space obliteration of
defects and facilitate immediate unimpaired wound healing
without adding extra bulk to permanently close the wound
while sparing other donor sites. With increasing popularity, free
TFL perforator flaps were raised for reconstruction of different
body regions [2, 3]. The local TFL perforator propeller flap
(TFLPP) for reconstruction of trochanteric pressure sores was
first described by Ishida et al. in 2005 . Then, Kim et al.
presented the concept of the TFL perforator-based island flap
for reconstruction of trochanteric ulcers . Both studies de-
scribe a flap design in which the flap is rotated for 90°.
To our best knowledge, the studies mentioned above are the
only existing reports in the literature covering the clinical appli-
cation of the TFLPP for reconstruction of trochanteric decubital
rotated for 180° in a patient with trochanteric pressure sores.
A 37-year-old male patient with a body mass index of 36.5 kg/
and diabetes mellitus type 2 with multiple sclerosis-
associated neurologic motor disability was referred to our de-
partment presenting with sacral, ischial, and trochanteric pres-
sure sores after previous treatment of the trochanteric
decubital ulcer. Temporarily, a vacuum-assisted-closure sys-
tem (V.A.C.® Kinetic Concepts Inc., San Antonio, TX, USA)
An abbreviated form of this manuscript was presented at the 51st annual
meeting of the Austrian Society of Plastic, Aesthetic, and Reconstructive
Surgery, October 3–5, 2013, in Velden, Austria.
* Paul Liebmann
Department of Plastic, Reconstructive and Aesthetic Surgery,
Krankenanstalt Rudolfstiftung Wien, Wien, Austria
Eur J Plast Surg (2016) 39:391–394