Lithotomy versus jackknife prone position in management of ischial pressure sores using fasciocutaneous V-Y advancement flap

Background:ischial pressure sores is the most common form of pressure sores in sitting paraplegic patients. It tends to have the highest rate of recurrence. Flap design for reconstruction should allow coverage of the ulcer without exhausting all donor areas and with minimal tension postoperatively and least recurrence rate ,a number of flaps were described for management, the most widely used is fasciocutaneous flap from the posterior thigh either in the form of rotational or advancement flap Aim:to evaluate which surgical position would exert minimal tension and least complications on the V-Y advancement flap postoperatively. Patients and methods:Intervention study (pilot study)was done from September2024 to February 2025 where Eighteen ischial pressure sores in fifteen patients were reconstructed by V-Y advancement flap seven in lithotomy position and eight in Jackknife prone position with shorter operative time in the lithotomy surgical position Group. Results:dehiscence only occurred in one reconstructed pressure sores in the lithotomy position Group while occurred in three flaps in the group operated in Jackknife prone position. Conclusion:harvesting the flap in lithotomy position allows harvesting the flap in the maximum tension position thus decrease the incidence of dehiscence and recurrence as well, also operating in lithotomy position has the advantage of Shorter operative time