Reconstruction of Symphysis Pubis Osteomyelitis Secondary to Chronic Ischial Pressure Sore Using a Biceps Femoris Turnover Flap: A Case Report

A 66-year-old man with paraplegia presented with a chronic right ischial pressure sore that had progressed despite previous outpatient follow-up. Initial evaluation revealed a 3×3 cm necrotic pressure sore that had undermined into a 7×10 cm cavity extending toward the symphysis pubis. Computed tomography and magnetic resonance imaging (MRI) demonstrated soft tissue defects in the right ischial region, with bone marrow signal abnormalities involving the right ischium and pubic symphysis suggestive of osteomyelitis (OM). MRI additionally revealed a periarticular abscess at the pubic symphysis with inflammatory extension toward the cutaneous opening at the right inguinal–ischial region. Because radical pubic bone resection carried a risk of pelvic instability that could compromise wheelchair seating balance, the surgical strategy prioritized preserving pelvic ring integrity. After debridement, the cavitary defect was reconstructed using an ipsilateral biceps femoris turnover flap. At 4 months postoperative, MRI demonstrated resolution of the symphysis pubis OM. The patient resumed wheelchair mobility without any complications. At 3-year follow-up, the healed wound remained stable and the patient maintained seated mobility. This case highlights successful management of symphysis pubis OM using a biceps femoris turnover flap while preserving pelvic ring stability without radical pubic bone resection.