The role of external fixation in the management of ischial tuberosity pressure ulcers in elderly patients: a two-center clinical study

The management of ischial tuberosity pressure ulcers in elderly patients remains a significant challenge in surgical treatment, with high risks of wound dehiscence and recurrence following traditional flap reconstruction. This study aimed to evaluate the efficacy of a novel external fixation technique designed to enhance flap adhesion and improve clinical outcomes in elderly patients undergoing ischial pressure ulcer repair. A retrospective two-center cohort study was conducted on 41 elderly patients with ischial tuberosity pressure ulcers treated between January 2018 and March 2024. Patients were divided into two groups: the fixation group ( n = 15), which received gluteus maximus flap reconstruction combined with external fixation, and the conventional group ( n = 26), which underwent traditional flap repair without fixation. Key outcomes included hospital stay duration, wound healing rates, postoperative complications, and ulcer recurrence at 6-month follow-up. Baseline characteristics, including age, ulcer size, and comorbidities, were comparable between groups ( P > 0.05). The fixation group demonstrated significantly shorter hospital stays (median 28 vs. 46 days, P < 0.05), lower postoperative complication rates (13.3% vs. 50.0%, P < 0.05), and recurrence at follow-up (0% vs. 23.1%, P < 0.05). All fixation group patients achieved complete wound closure, with no fixation-related adverse events. External fixation significantly improved flap stability, reduced complications, and prevented recurrence in elderly patients with ischial pressure ulcers. This technique serves as a promising adjunct to traditional flap reconstruction by addressing biomechanical challenges, particularly in high-risk elderly populations. Further randomized trials are warranted to validate its broader applicability.