Reconstructing Bilateral Ischial Sores with a Single Hamstring Flap versus Dual Plane Flaps: A Case Report

The reconstruction of bilateral ischial pressure sores presents a formidable challenge in reconstructive plastic surgery. Adequate padding over the ischial tuberosity and proper resurfacing of the defect are critical in preventing recurrence after reconstruction. We present a case of bilateral ischial sores reconstructed using two different approaches. A 62-year-old paraplegic man with bilateral ischial sores and osteomyelitis of both ischial tuberosities presented to the plastic surgery department. After serial debridement, the 6×4 cm ischial sore on the left side was reconstructed using dual-plane flaps—two independent flaps consisting of a biceps femoris muscle flap and a perforator-based fasciocutaneous island flap. The 7×4 cm ischial sore on the right side was reconstructed using a single hamstring flap, a composite flap consisting of a semitendinosus muscle flap with a distally linked skin flap. Both defects were successfully reconstructed, and the patient regained wheelchair ambulation. Both approaches—the dual-plane flaps and the single hamstring flap—are effective options for ischial sore reconstruction, as they provide sufficient volume and adequate resurfacing. Given the hamstring flap’s capacity to significantly reduce operative duration, it may be considered the primary surgical option. However, in the absence of a reliable perforator between the hamstring muscle and the overlying skin, dual-plane flaps should be selected.