Perforator-Based Propeller Flap Application in Pressure Ulcer Reconstruction: A Comparative Analysis With Advancement Flaps

Background Pressure ulcers are a prevalent and debilitating condition, often necessitating surgical reconstruction. Various flap techniques, such as Advancement Flaps (AF) and Perforator-based Propeller Flaps (PBPF), are commonly used for pressure sore reconstruction. While both techniques have proven effective, there is limited research comparing their outcomes in different clinical scenarios. In recent years, PBPF has demonstrated favorable outcomes in various reconstruction fields. However, there remains a need to establish the optimal technique for specific clinical conditions and patient populations. Therefore, this study aims to compare the outcomes of PBPF and AF in patients undergoing pressure ulcer reconstruction. Methods A retrospective analysis was performed on patients who underwent pressure sore reconstruction utilizing either AF or PBPF techniques between January 2020 and December 2023. Data on demographics, pressure ulcer details, operative time, hospital stay, recurrence rate, and complications were collected and analyzed. Results In this study of 56 patients, 30 underwent AF, and 26 underwent PBPF. Demographic and clinical characteristics showed no significant differences. Clinical and surgical outcomes indicated no significant differences in defect size (p = 0.517), hospitalization period (p = 0.786), follow-up duration (p = 0.746), number of preoperative debridements (p = 0.781), time to recurrence (p = 0.224), or postoperative complications (p = 0.757). However, PBPF resulted in a smaller flap size (93.7 +/- 29.5 cm2 for AF vs. 70.5 +/- 19.7 cm(2) for PBPF, p < 0.001), a longer operation time compared to AF (94.6 +/- 39.1 min for AF vs. 161.0 +/- 38.9 min for PBPF, p < 0.001), and lower recurrence rate in long-term follow-up (p = 0.036). Conclusions PBPF may have the drawback of prolonged surgical time due to the complexity of the surgical procedure. However, when applied appropriately, it can be a meaningful surgical approach for reducing the recurrence rate of pressure ulcers.