Flap Selection in Pressure Ulcer Reconstruction Using a Longitudinal Archive of Ten Representative Cases for the Board Certification Examination of the Japan Society of Plastic and Reconstructive Surgery

Background: The selection of reconstructive procedures for pressure ulcers varies according to the anatomical site and institutional experience.This study aimed to describe the current institutional trends in fl ap selection for pressure ulcer reconstruction.Methods: We retrospectively reviewed the records of 74 residents from our department who submitted ten representative cases for the board certifi cation examination of the Japan Society of Plastic and Reconstructive Surgery between 1997 and 2025.The data included the anatomical regions of pressure ulcers and the reconstructive procedures employed.Results: Of the 74 residents, 63 included one or two cases of pressure ulcers.A total of 39 sacral, 23 ischial, and 13 trochanteric ulcers were reconstructed.Perforator-based fasciocutaneous fl aps were predominantly used for sacral ulcers (n = 38), with posterior thigh fl aps used in one.Posterior thigh fl aps (n = 21) and hamstring myocutaneous fl aps (n = 2) were used for ischial ulcers.Trochanteric ulcers were reconstructed using tensor fascia lata myocutaneous fl aps (n = 11) and posterior thigh fl aps (n = 2).Combined reconstructions were performed in two cases: one involved the simultaneous use of a perforator-based fl ap for a sacral ulcer and a posterior thigh fl ap for an ischial ulcer, while the other involved bilateral posterior thigh fl aps for sacral and bilateral ischial ulcers.Conclusions: Perforator-based fasciocutaneous fl aps were the most common choice for sacral ulcers, posterior thigh fl aps for ischial ulcers, and tensor fascia lata fl aps for trochanteric ulcers, refl ecting anatomical suitability and evolving surgical practices.