Abstract
Pressure ulcers mostly occur at the sacral, trochanteric and ischial area after a long time of bony structure compression over the soft tissue and leading to soft tissue ischemia. Treatment of pressure ulcers ranging from pressure-relieving measures to surgical intervention. Herein, we would like to introduce a new, safe and effective way, the pedicled PAP flap as propeller flap, for ischial pressure ulcer reconstruction at E-Da Hospital.

Case report:
We report a case of a 54-year-old bedridden female patient due to thoracic 6-7 level intrathecal meningioma and eventually develop a grade 4 right ischial pressure ulcer. After intrathecal meningioma excision, her bilateral lower leg numbness and power improved. We start to do debridement for the ischial pressure ulcer and finally we use pedicled PAP flap as propeller flap for ischial pressure ulcer reconstruction. After 3 weeks of the operation, we remove the stitches and discharge the patient. The flap survives well without necrosis or wound dehiscence.
This method is a new, safe and effective way for ischial pressure ulcer reconstruction. During operation, a prone position is needed. The flap has a reliable pedicle and provides a bulk of soft tissue as a cushion for ischial defect coverage and protection.

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