Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores

Abstract

To compare the outcomes of gluteal fasciocutaneous rotational flaps and myocutaneous flaps in the treatment of sacral sores, together with a review of surgical complications in two matched cohorts. Thirty-eight patients (18 gluteal fasciocutaneous rotational flaps and 20 myocutaneous flaps) were reviewed retrospectively at a mean follow-up of 58 weeks. The rate of healing of the sore, the sore healing time, and the incidence of surgical complications, together with rate of recurrence, were obtained by chart review. Treatment groups were matched by patient characteristics, operative time and blood loss. The rate of healing of the sore, sore healing time and complication rate were comparable in the two groups but the rate of recurrence was lower to a statistically significant extent in myocutaneous flap patients. The authors suggest that both methods are comparable, good and safe in treating sacral sores; myocutaneous flaps are more durable.Résumé Comparer l'issue de deux types de lambeaux de rotation prélevés à partir de muscles fessiers-facio-cutanés ou myo-cutanés-dans le traitement des escarres sacrales, avec une examination des complications chirurgicales chez deux cohortes de patients. Trente-huit patients (18 lambeaux de rotation fessiers facio-cutanés et 20 myo-cutanés), ont été revus de façon prospective après un suivi moyen de 58 semaines. Ceci a permis d'obtenir un score de guérison de l'escarre, ainsi que le temps de guérison, et d'apprécier également les complications chirurgicales et la proportion de réapparition. Les groupes de traitement ont été répartis en fonction des caractéristiques des patients, du temps opér-atoire et de la perte sanguine. L'évaluation de la guérison de l'escarre, ainsi que le temps de guérison et la proportion des complications ont été comparables entre les deux groupes, mais la proportion de réapparition est inférieure de façon statistiquement significative chez les patients ayant bénéficié d'un lambeau myo-cutané. les auteurs pensent que les deux méthodes sont comparables. Tous les deux donnent un bon résultat avec sécurité dans le traitement des escarres sacrales, mais le lambeau myo-cutané semble plus durable que le lambeau facio-cutané.

Preoperative Albumin Alone is Not a Predictor of 30-Day Outcomes in Pressure Ulcer Patients

“…6,8,26 The wide disparity in reported recurrence rates is due, in large part, to a lack of standard definitions for endpoints, as well as wide variation in length of follow-up, with shorter studies reporting much lower recurrence rates. 27,28 Pressure ulcer recurrence has been established to plateau at 15 to 22 months postoperatively (well outside the 30-day window tracked in NSQIP). 6,26,29,30 However, failure of surgical treatment appears to occur on a continuum from immediate operative failure through dehiscence to recurrence, with earlier failures being associated with the patient's healing capacity and tissue quality, and later recurrences associated with failure of preventative measures.…”

Multivariate Predictors of Failure after Flap Coverage of Pressure Ulcers

“…16,18 The wide disparity in reported recurrence rates is due, in large part, to a lack of standard definitions for endpoints, as well as wide variation in length of follow-up, with shorter studies reporting much lower recurrence rates. 27,28 Despite advances in surgical technique and postoperative management, studies of flap coverage have shown no improvements. 16,29 -31 Within the last 10 years, reported dehiscence rates have ranged between 9 and 45 percent.…”

A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients

“…For example, Wong et al described the difference in complications between 18 gluteal fasciocutaneus rotational and 20 myocutaneus flaps. 22 The 12-month follow-up investigation revealed that complications in the first group was 17% and in the second group 15%. 22 Findings were not presented in a useful manner, because the grouping of flaps was too general.…”

“…22 The 12-month follow-up investigation revealed that complications in the first group was 17% and in the second group 15%. 22 Findings were not presented in a useful manner, because the grouping of flaps was too general. It does not account for all factors affecting the appearance of complications as discussed above.…”