Abstract

This study aims to evaluate the clinical outcomes of combining a muscle flap with a rotational fasciocutaneous flap in the surgical treatment of stage III–IV pressure ulcers, focusing on postoperative complications and recurrence rates. Seventeen patients who underwent surgery with rotation flap over a muscle flap combination for stage III–IV ischial or adjacent region pressure ulcers between January 2024 and January 2026 were retrospectively analyzed. Demographic characteristics, defect localization and size, postoperative complications, need for reoperation, and recurrence rates were investigated. Of the patients included in the study, 16 were male (94.1%), and 1 was female (5.9%). The average age was 45.9 years. Two-layer flap reconstruction was used in all patients; In this technique, muscle flaps were used to obliterate deeper defects, while rotational fasciocutaneous flaps were used to close the upper surface, creating a mechanically resistant covering. In the early postoperative period, complications developed in 3 patients. One patient underwent surgical drainage for haematoma, and two patients required resuturing due to wound dehiscence. In the follow-up period, no flap perfusion problems were observed, recurrence occurred in one patient, and no mortality was recorded. The two-layered reconstruction technique using a combined muscle flap and rotational fasciocutaneous flap is a reliable and effective method for the surgical treatment of advanced pressure ulcers. This approach offers advantages for obliterating deep defects and providing superficial mechanical resistance. However, larger patient series and long-term follow-up data are needed to demonstrate long-term efficacy and recurrence rates more clearly.

Key words: Ischial ulcer, muscle flap, pressure ulcer, random flap, rotation flap