Flap coverage for sacral and ischial pressure-induced injury

This patient with paraplegia suffered from pressure-induced injuries overlying the sacrum and ischial tuberosities bilaterally (A). Following debridement, NPWT with instillation (B) was used to prepare the wound base for staged repair. Closure of the sacral and left ischial wounds was accomplished with V-to-Y advancement fasciocutaneous flaps (C). The large right ischial wound was covered with a myofasciocutaneous advancement flap with inclusion of the hamstring muscles (D).