Abstract
Study design:
Description of a technique and prospective follow-up study.
Objectives:
The aim of this study was to present our experience in the surgical treatment of ischial pressure sores, especially recurrence.
Setting:
The Department of Plastic and Reconstructive Surgery and Spinal Injuries Unit, CTO Hospital, Rome, Italy.
Methods:
From 1995 to 1997, the authors used in 12 consecutive paraplegic patients, who had a grade III or IV decubitus ulcer in the ischial area only, two different and independent flaps coupled together in a ‘criss-cross’ musculocutaneous flap: a split-muscle gluteus maximus flap and a rhomboid fasciocutaneous local flap. The average follow-up period was 3 years and 9 months. Details of the operative procedure are presented to prove that this criss-cross closure of the ischial pressure sore beneficial for patients with spinal cord injury.
Results:
All flaps survived; recurrence of the decubitus ulcer occurred in one patient (8%). Pressure-sore-free survival after surgery was 20 months in the patient with recurrence and an average of 26 months in patients without recurrence.
Conclusion:
The results obtained confirm this procedure to be safe and useful. We believe this technique to be a valuable alternative for the reconstruction of primary or recurrent ischial pressure ulcers.
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References
Relander M, Palmer B . Recurrence of surgically treated pressure sores. Scand J Plast Reconstr Surg 1988; 22: 89–92.
Disa JJ, Carlton JM, Goldberg NH . Efficacy of operative cure in pressure sore patients. Plast Reconstr Surg 1992; 89: 272–278.
Mandrekas AD, Mastorakos DP . The management of decubitus ulcers by musculocutaneous flaps: a five-year experience. Ann Plast Surg 1992; 28: 167–174.
Rimareix F, Lortat-Jacop A . Comparative study of 2 surgical techniques in the treatment of ischial pressure ulcers in paraplegic patients: retrospective study of 90 cases. Ann Chir Plast Esthet 2000; 45: 589–596.
Yamamoto Y, Tsutsumida A, Murazumi M, Sugihara T . Long-term outcome of pressure sores treated with flap coverage. Plast Reconstr Surg 1997; 100: 1212–1217.
Mathes SJ, Alpert B . Advances in muscle and musculocutaneous flaps. Clin Plast Surg 1980; 7: 15–26.
Hurteau JE, Bostwick J, Nahai F, Hester R, Jurkiewicz MJ . V-Y advancement of hamstring musculocutaneous flap for coverage of ischial pressure sores. Plast Reconstr Surg 1981; 68: 539–542.
Angrigiani C, Grilli D, Siebert J, Thorne C . A new musculocutaneous island flap from the distal thigh for recurrent ischial and perineal pressure sores. Plast Reconstr Surg 1995; 96: 935–940.
Fisher J, Arnold PG, Waldorf J, Woods JE . The gluteus maximus musculocutaneous V-Y advancement flap for large sacral defects. Ann Plast Surg 1983; 11: 517–522.
Stevenson TR, Pollock RA, Rohrich RJ, Vanderkolk CA . The gluteus maximus musculo-cultaneous island flap: refinements in design and application. Plast Reconstr Surg 1987; 79: 761–768.
Parkash S, Banerjee S . The total gluteus maximus rotation and other gluteus maximus musculocutaneous flaps in the treatment of pressure ulcers. Br J Plast Surg 1986; 39: 66–71.
Jósvay J, Sashegyi M, Kelemen P, Donáth A . Clinical experience with the hatchet-shaped gluteus maximus musculocutaneous flap. Ann Plast Surg 2005; 55: 179–182.
Baran CN, Celebioğlu S, Civelek B, Sensöz O . Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores. Plast Reconstr Surg 1999; 103: 2071–2077.
Gould WL, Montero N, Cukic J, Hagerty RC, Hester TR . The ‘split’ gluteus maximus musculocutaneous flap. Plast Reconstr Surg 1994; 93: 330–336. Comment in Plast Reconstr Surg. 1995; 95: 941–942.
Ramirez O, Swartz WM, Futtrell JW . The gluteus maximus muscle: experimental and clinical considerations relevant to reconstruction in ambulatory patients. Br J Plast Surg 1987; 40: 1–10.
Yamamoto Y, Ohura T, Shintomi Y, Sugihara T, Nohira K, Igawa H . Superiority of the fasciocutaneous flap in reconstruction of sacral pressure sores. Ann Plast Surg 1993; 30: 116.
Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T . Triple coverage of ischial ulcers with adipofascial turnover and fasciocutaneous flaps. Plast Reconstr Surg 2004; 114: 901–905.
Coşkunfirat OK, Ozgentaş HE . Gluteal perforator flaps for coverage of pressure sores at various locations. Plast Reconstr Surg 2004; 113: 2012–2017; discussion 2018-9.
Aydin G, Zekeriya K, Zafer O . Long-term outcome with the adductor perforator flap for ischial pressure sores. Plast Reconstr Surg 2008; 122: 49e–50e.
Homma K, Murakami G, Fujioka H, Fujita T, Imai A, Ezoe K . Treatment of ischial pressure ulcers with a posteromedial thigh fasciocutaneous flap. Plast Reconstr Surg 2001; 108: 1990–1996; discussion 1997.
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Borgognone, A., Anniboletti, T., De Vita, F. et al. Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way. Spinal Cord 48, 770–773 (2010). https://doi.org/10.1038/sc.2010.25
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DOI: https://doi.org/10.1038/sc.2010.25
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