Versatility of Tensor Fascia Lata Musculocutaneous Flap in the Management of Grade III & IV Trochanteric Pressure Ulcer

Background: Trochanteric pressure sore is the 2"' most common type of pressure sores and different surgical techniques and modifications of tensor fascia lata musculocutaneous flap had been developed. Objective: This is a prospective study that had been designed to evaluate using different surgical techniques of tensor fascia lata musculocutaneous flap in closure of grade III & IV trochanteric sore and the risk of complications. Methods: This is a prospective study which enrolled 15 patients with trochanteric pressure sore. The sample of this study had been selected from those patients admitted to Ibn Al-Kuff Hospital for Spinal Cord Injury during the period between March 2008 and September 2009. Results: Ten patients had been treated surgically with classical rotation tensor fascia lata flap, four patients had been treated by using V-Y advancement technique and only one patient had been treated with island approach. The vertical diameter of the trochanteric pressure sores which had been treated surgically using the classical rotation advancement tensor fascia lata flap was 8.5 cm while the vertical diameter of those ulcers treated by V-Y advancement was 3.97cm. Donor site had been closed directly in all of the 4 patients with V-Y advancement technique, and skin grafting was applied to all of the 10 patients treated with classical rotation technique and to the patient that was treated with island flap. All of the 10 patients, who had been treated with the classical rotation tensor fascia lata flap, had trochanteric pressure sore of 5 cm or more vertical diameter. On the other hand, all of trochanteric sore that had been treated with V-Y advancement had a vertical diameter of less than 5 cm. Five of the 10 patients with classical rotation advancement tensor fascia lata flap had no complications during the period of post-operative care. Only 1 patient treated with V-Y advancement tensor fascia lata flap developed post-operative complication (dehiscence). Dog ear deformity had been found in 4 patients treated with classical rotation technique, while none of those treated with the V-Y advancement technique had developed such a deformity. Conclusion: V-Y advancement tensor fascia lata flap is more applicable for smaller sized ulcers; its use makes the reconstructive surgeon able to directly close the donor site without using a skin graft, it is associated with less complications and dog ear deformity is eliminated by the usage of this technique. In addition, Classical rotation flap can be applied for any size of trochanteric ulcer despite the need for donor site closure by skin graft and the possibility of having more complications and the development of dog ear deformity which particularly appears with small sized flap