Outcome of Bilateral V‑Y Advancement Flap for Management of Gluteal Pressure Injury in Spinal Cord Injured Patients at National Orthopaedic Hospital Dala Kano Nigeria

Background: Pressure injuries are a common and devastating complication in spinal cord injured patients, leading to prolonged hospitalization and significant morbidity. Surgical reconstruction with flaps provides durable, vascularized tissue coverage over bony prominences. This study evaluated the outcomes of bilateral V-Y advancement flaps for gluteal pressure injuries, including patient satisfaction and quality of life, in spinal cord injured patients at a Nigerian tertiary centre. Methods: A retrospective cohort study of 63 patients who underwent bilateral V-Y advancement flap reconstruction for gluteal and sacral pressure injuries at the National Orthopaedic Hospital Dala, Kano, from January 2019 to June 2025 was conducted. Outcomes assessed included flap survival, wound healing, complications, recurrence, patient satisfaction, and quality of life (SF-36). Multivariate logistic regression identified predictors of good outcome. Results: Complete flap survival was achieved in 61 patients (96.8%). Primary healing occurred in 48 patients (76.2%). Complications occurred in 15 patients (23.8%): dehiscence (9.5%), seroma (6.3%), infection (4.8%), and partial necrosis (3.2%). Recurrence occurred in 7 patients (11.1%) during follow-up. Patient satisfaction was high, with 82.5% reporting satisfaction with surgical outcomes. Quality of life significantly improved across physical (p < 0.001) and emotional (p < 0.001) domains. Independent predictors of good outcome included: age < 50 years (adjusted OR 3.2, 95% CI: 1.4 - 7.3), absence of diabetes mellitus (OR 2.8, 95% CI: 1.2 - 6.5), and adequate postoperative pressure off-loading (OR 4.1, 95% CI: 1.6 - 10.5). Conclusions: Bilateral V-Y advancement flap is an effective technique for gluteal pressure injury reconstruction, with high flap survival, acceptable complication rates, and significant improvements in patient satisfaction and quality of life. Younger age, absence of diabetes, and adequate postoperative off-loading are significant predictors of successful outcomes.