Distally extended tensor fascia lata flap including the wide iliotibial tract for reconstruction of trochanteric pressure sores

SummaryThe distally extended tensor fascia lata flap is a good choice to provide sufficient tissue bulk for a deep trochanteric sore defect. However, this flap can result in necrosis of the distal skin due to inadequate blood supply, failure of primary closure at the donor site or suture separation at the proximal donor site. The viability of the distal flap depends on the longitudinal subcutaneous plexi of the perforators anastomosing through multiple small-calibre vessels. If the subcutaneous and fasciocutaneous plexi are maximally preserved, the distal flap may be viable. It may also allow the flap to be narrower at the proximal portion, allowing the donor site to be primarily closed without tension. We performed a V-shaped, distally de-epithelialised, extended tensor fascia lata flap with a wide base of the iliotibial tract. The de-epithelialised distal flap was double-folded to fill the dead space of the defect. A key surgical tip to improve blood supply to the distal flap was to preserve the iliotibial tract 1.5 cm beyond both borders of the V-shaped skin incision. A total of 14 trochanteric wounds were successfully covered in 11 patients without complication. This flap had the advantages of having soft-tissue bulk, a reliable blood supply and primary donor-site closure. This flap may provide a good option for the reconstruction of deep trochanteric pressure sores.