Inferior Gluteal Artery Perforator Propeller Flap Elevated in the Superficial Fascial Plane for Ischial Pressure Sore Reconstruction: A Case Report

Pressure sores are common in immobilized patients, particularly in the gluteal region, and advanced ulcers often require surgical reconstruction. The inferior gluteal artery perforator (IGAP) flap is preferred because it preserves muscle and reduces donor morbidity. We report a 55-year-old woman with paraplegia and a right ischial pressure ulcer. Reconstruction was achieved using an IGAP propeller flap elevated in the superficial fascial plane, allowing 180-degree rotation and tension-free closure. This technique provided adequate bulk while preserving the gluteal muscle and deep fat compartment, supporting future reconstructive options. The flap also offered stable perfusion and adaptability for contouring the defect. Postoperative recovery was largely uneventful, with complete flap viability at the ischial defect; a minimal donor site opening developed and was successfully managed with a split-thickness skin graft. This case demonstrates that superficial fascial plane IGAP propeller flaps represent a reliable, tissue-sparing, and versatile option for ischial pressure ulcer reconstruction in practice.