Complex reconstructive surgery for a recurrent ischial pressure ulcer with contralateral muscle

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The management of recurrent pressure ulcers is a frequent problem in patients with spinal cord injuries. Many local muscle and fasciocutaneous flaps can be used to cover ulcers of all sizes. However, when a recurrent pressure ulcer has been repeatedly addressed, the number of available flaps becomes quite limited. Contralateral muscles, such as the gracilis, can be used to cover recurrent ischioperineal ulcers and should be employed before last resort surgeries, such as hip disarticulation and the total thigh flap.
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