ISCHIAL RECONSTRUCTION WITH DISTAL FEMORAL BICEPS MUSCLE FLAP IN A PATIENT WITH GRADE IV PRESSURE ULCER: CASE REPORT

Abstract

Grade IV pressure ulcers in the ischial region represent a challenging reconstructive problem, particularly in neurologically compromised patients. We present the case of a 50-year-old male patient with a history of stroke and chronic ischial grade IV pressure ulcer, managed by a pedicled femoral biceps muscle flap with distal skin island. Extensive surgical debridement, complete bursectomy, and superficial partial ischial osteotomy were performed, followed by proximal mobilization of the femoral biceps muscle flap. The surgical procedure was completed uneventfully, achieving effective defect coverage with adequate vascularization and minimal tension. A minor postoperative seroma was detected during immediate follow-up and successfullymanaged with percutaneous needle aspiration. Although the immediate results were favorable with no significant complications, the short follow-up period limits conclusions regarding sustained clinical effectiveness and recurrence. This case indicates that thefemoral biceps muscle flap is a technically suitable reconstructive option for complex ischial defects; however, further studies with prolonged follow-up are necessary to evaluate its definitive clinical efficacy.