European Journal of Plastic Surgery

, Volume 36, Issue 10, pp 639–644 | Cite as

Biceps femoris flap for closure of ischial pressure ulcers

  • Nicolas BertheuilEmail author
  • Vincent Huguier
  • Sylvie Aillet
  • Marion Beuzeboc
  • Eric Watier
Original Paper



The surgical management of stages III and IV pressure ulcers in spinal cord injury patients is ussually based on a large debridment of necrotic tissue before performing a cover of the defect by a flap. The purpose of our study is to analyze our results in terms of morbidity and recurrence of pressure ulcers covered by biceps femoris musculocutaneous flap and compares it with literature data.


A retrospective clinical study of 23 consecutive patients operated for stage IV ischial pressure ulcers by biceps femoris flap was carried out. Other surgical techniques coverage of pressure ulcers as well as all patients with pressure ulcers on another anatomical location were excluded from this study. An analytical statistics in search of a risk factor for recurrence by log rank test was also performed.


The mean follow-up was 68.4 months. Primary healing was obtained without complications in 30.8 and 38.4 % had a recurrence of the ulcer. Seroma was statistically correlated to a significant risk of recurrence of pressure ulcers (p = 0.0284, log rank test), as well as to drains removal before the eighth day (p = 0.0114).


Surgical management of ischial pressure ulcers remains as a difficult procedure with significant postoperative complications and a high recurrence rate.

Level of Evidence: Level IV, therapeutic study.


Pressure ulcer Myocutaneous flap Biceps femoris flap Reconstructive surgery 



The authors wish to thank Dr Cédric Ménard for English language corrections of the manuscript and Dr Boris Campillo-Gimenez for statistical analysis.

Conflict of interest



  1. 1.
    Le Chapelain L, Fyad JP, Beis JM, Thisse MO, Andre JM (2001) Early surgery management of pelvic region pressure ulcers versus directed cicatrization in a population of spinal cord injured patients. Ann Readapt Med Phys 44:608–612PubMedCrossRefGoogle Scholar
  2. 2.
    Byrne DW, Salzberg CA (1996) Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord 34:255–263PubMedCrossRefGoogle Scholar
  3. 3.
    Keys KA, Daniali LN, Warner KJ, Mathes DW (2010) Multivariate predictors of failure after flap coverage of pressure ulcers. Plast Reconstr Surg 125:1725–1734PubMedCrossRefGoogle Scholar
  4. 4.
    Tavakoli K, Rutkowski S, Cope C et al (1999) Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study. Br J Plast Surg 52:476–479PubMedCrossRefGoogle Scholar
  5. 5.
    Conway H, Griffith BH (1956) Plastic surgery for closure of decubitus ulcers in patients with paraplegia; based on experience with 1,000 cases. Am J Surg 91:946–975PubMedCrossRefGoogle Scholar
  6. 6.
    Tchanque-Fossuo CN, Kuzon WM Jr (2011) An evidence-based approach to pressure sores. Plast Reconstr Surg 127:932–939PubMedCrossRefGoogle Scholar
  7. 7.
    Voulliaume D, Grecea M, Viard R, Brun A, Comparin JP, Foyatier JL (2011) Surgical issues and outcomes in ischial pressure sores treatment. Ann Chir Plast Esthet 56:528–539PubMedCrossRefGoogle Scholar
  8. 8.
    Dansereau JG, Conway H (1964) Report of 2000 cases. Plast Reconstr Surg 33:474–480PubMedCrossRefGoogle Scholar
  9. 9.
    Sanchez S, Eamegdool S, Conway H (1969) Surgical treatment of decubitus ulcers in paraplegics. Plast Reconstr Surg 43:25–28PubMedCrossRefGoogle Scholar
  10. 10.
    Dhami LD, Gopalakrishna A, Thatte RL (1985) An objective study of the dimensions of the ischial pressure point and its correlation to the occurrence of a pressure sore. Br J Plast Surg 38:243–251PubMedCrossRefGoogle Scholar
  11. 11.
    Karaca AR, Binns JH, Blumenthal FS (1978) Complications of total ischiectomy for the treatment of ischial pressure sores. Plast Reconstr Surg 62:96–99PubMedCrossRefGoogle Scholar
  12. 12.
    Kauer C (1985) Ischiatic pressure sores: reconstruction of the gluteal fold. Ann Chir Plast Esthet 30:171–174PubMedGoogle Scholar
  13. 13.
    Foster RD, Anthony JP, Mathes SJ, Hoffman WY (1997) Ischial pressure sore coverage: a rationale for flap selection. Br J Plast Surg 50:374–379PubMedCrossRefGoogle Scholar
  14. 14.
    Yamamoto Y, Tsutsumida A, Murazumi M, Sugihara T (1997) Long-term outcome of pressure sores treated with flap coverage. Plast Reconstr Surg 100:1212–1217PubMedCrossRefGoogle Scholar
  15. 15.
    Quaba AA, Chapman R, Hackett ME (1988) Extended application of the biceps femoris musculocutaneous flap. Plast Reconstr Surg 81:94–105PubMedCrossRefGoogle Scholar
  16. 16.
    Mathes SJ, Nahai F (1981) Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 67:177–187PubMedGoogle Scholar
  17. 17.
    Hurteau JE, Bostwick J, Nahai F, Hester R, Jurkiewicz MJ (1981) V-Y advancement of hamstring musculocuataneous flap for coverage of ischial pressure sores. Plast Reconstr Surg 68:539–542PubMedCrossRefGoogle Scholar
  18. 18.
    James JH, Moir IH (1980) The biceps femoris musculocutaneous flap in the repair of pressure sores around the hip. Plast Reconstr Surg 66:736–739PubMedCrossRefGoogle Scholar
  19. 19.
    Tobin GR, Sanders BP, Man D, Weiner LJ (1981) The biceps femoris myocutaneous advancement flap: a useful modification for ischial pressure ulcer reconstruction. Ann Plast Surg 6:396–401PubMedCrossRefGoogle Scholar
  20. 20.
    Mateu J, Laurent B, Rouif M, Ballon G, Greco JM (1991) Covering of ischial pressure sores using a fasciocutaneous flap from the posterior surface of thigh (modified Griffith method) after mattressing with the biceps femoris. About 11 cases. Ann Chir Plast Esthet 36:337–346PubMedGoogle Scholar
  21. 21.
    Watier E, Chevrier S, Georgieu N, Pardo A, Schück S, Pailheret JP (2000) Our experience with ischial pressure sores in a series of 34 patients. Eur J Plast Surg 23:32–523CrossRefGoogle Scholar
  22. 22.
    Thiessen FE, Andrades P, Blondeel PN et al (2011) Flap surgery for pressure sores: should the underlying muscle be transferred or not? J Plast Reconstr Aesthet Surg 64:84–90PubMedCrossRefGoogle Scholar
  23. 23.
    Kierney PC, Engrav LH, Isik FF, Esselman PC, Cardenas DD, Rand RP (1998) Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine. Plast Reconstr Surg 102:765–772PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nicolas Bertheuil
    • 1
    • 2
    Email author
  • Vincent Huguier
    • 3
  • Sylvie Aillet
    • 1
  • Marion Beuzeboc
    • 1
  • Eric Watier
    • 1
  1. 1.Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital SudUniversity of Rennes 1RennesFrance
  2. 2.INSERM U917University of Rennes 1RennesFrance
  3. 3.Department of Plastic and Reconstructive SurgeryPoitiers University HospitalPoitiersFrance

Personalised recommendations