{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T09:19:26Z","timestamp":1774343966564,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic wounds are a major source of morbidity in patients with paraplegia, often resulting in repeated treatment, prolonged hospitalization, and reduced quality of life. Reconstruction becomes particularly challenging when a wound arises in a scarred trunk region and is further complicated by deep infection, osteomyelitis, or enteric fistula. We describe the staged management of a complex left flank wound in a paraplegic patient, initially reconstructed with a quadrilateral pinwheel flap and later requiring multidisciplinary salvage for recurrence associated with rib osteomyelitis and a colocutaneous fistula. Methods: A paraplegic man in his 50s presented with a chronic left flank wound after repeated full-thickness skin graft failure and persistent Pseudomonas aeruginosa infection. After wide debridement, the approximately 7 \u00d7 7 cm defect was reconstructed with a quadrilateral pinwheel flap composed of four Limberg-style rhomboid fasciocutaneous flaps positioned at the 12, 3, 6, and 9 o\u2019clock orientations, elevated at the level of the deep fascia, and transposed into the central defect, with adjunctive negative-pressure wound therapy (NPWT). Approximately 1 year later, recurrence with rib osteomyelitis required rib resection. During NPWT, feculent drainage led to the diagnosis of a colocutaneous fistula. Subsequent multidisciplinary treatment included fistula tract resection, colonic repair with omental patching, transposition of vascularized omentum into the chest wall cavity to obliterate dead space, continued NPWT, and delayed primary closure. Results: Initial local flap reconstruction achieved wound coverage, and immediate postoperative clinical assessment, including pinprick and refill testing, confirmed satisfactory flap perfusion; however, delayed recurrence developed in association with rib osteomyelitis. After definitive fistula surgery, dead-space management with vascularized omentum, wound conditioning with staged NPWT, and delayed primary closure, the wound healed completely. At 6 months after delayed closure, no recurrence of fistula, osteomyelitis, wound dehiscence, or soft-tissue breakdown was observed, and the patient\u2019s daily comfort and functional independence were improved compared with the preoperative condition. Conclusions: A quadrilateral pinwheel flap may provide an effective tension-dispersing local fasciocutaneous option for selected scarred trunk defects in high-risk patients. However, when chronic wounds are compounded by deep infection and enteric fistula, durable healing depends not on flap design alone but on staged multidisciplinary management incorporating definitive source control, vascularized tissue transfer for dead-space elimination, NPWT, and appropriately timed closure.<\/jats:p>","DOI":"10.3390\/jcm15062394","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:02:43Z","timestamp":1774026163000},"page":"2394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quadrilateral Pinwheel Flap Reconstruction for a Complex Colocutaneous Fistula-Associated Flank Wound in a Paraplegic Patient: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Joon Hyuk","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae Gon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1179\/2045772313Y.0000000093","article-title":"Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends","volume":"36","author":"Kruger","year":"2013","journal-title":"J. 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Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3109\/2000656X.2012.736387","article-title":"Versatility of the pinwheel flap to reconstruct circular defects in the temporal and scalp region","volume":"47","author":"Simsek","year":"2013","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e229420","DOI":"10.1136\/bcr-2019-229420","article-title":"Application of the pinwheel flap for closure of a large defect of the scalp","volume":"12","author":"Varnalidis","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/0007-1226(87)90189-5","article-title":"\u201cA square peg into a round hole\u201d: A modified rhomboid flap and its clinical application","volume":"40","author":"Quaba","year":"1987","journal-title":"Br. J. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.22467\/jwmr.2025.03398","article-title":"Reconstruction of anterior chest wall defect using an omental flap and split-thickness skin graft: A case report","volume":"21","author":"Kim","year":"2025","journal-title":"J. Wound Manag. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:47:52Z","timestamp":1774331272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062394"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062394","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}