Rotation flaps in the treatment of ischial pressure sores – the bigger the better

Garner, Jeff; Teo, TC

doi:10.1038/sj.sc.3101056

Cited by 2 publications

(4 citation statements)

References 4 publications

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“…Flap selection should follow the guidelines of designing a flap as large as possible and placing the suture line away from the area of direct pressure. 16 The flap should not violate adjacent flap territories so as to preserve options for coverage in the event subsequent breakdown or recurrence dictates further reconstruction. 17 Fasciocutaneous flaps have been demonstrated to be as advantageous as muscle flaps in pressure ulcer reconstruction, with minor residual morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…19 Rotation fasciocutaneous flaps offer the advantage to be readvanced in case of recurrence without jeopardizing another vascular supply. 16 Conventional methods of wound closure usually address the superficial soft-tissue closure, leaving shearing forces to act over the bony prominence to enlarge the undermined area. Deepithelialized flaps have been used previously for pressure ulcers, demonstrating decreased recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

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Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Gargano

Edstrom

Szymanski³

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Surgical treatment of pressure ulcers is challenging for high recurrence rates. Deepithelialized flaps have been used previously with the aim to eliminate shearing forces and the cone of pressure (COP) effect. The goal of this study is to adopt a standardized protocol and evaluate if 2 different flap techniques affect outcomes.Methods:The novel COP flap is illustrated. Twenty patients were prospectively treated with flap coverage over a 36-month period. According to the flap type, patients were assigned to 2 groups: group 1 with 11 patients treated with the COP flap and group 2 with 9 patients treated with conventional flap without anchoring technique. We adopted a standardized protocol of debridement, tissue cultures, and negative-pressure wound therapy. Rotation fasciocutaneous flaps were used for both groups and mean follow-up was 19 months. The COP flap is a large deepithelialized rotation flap inset with transcutaneous nonabsorbable bolster sutures. The 2 groups were comparable for demographics and ulcer location and size (P < 0.05). Five patients showed positive cultures and were treated with antibiotics and negative-pressure therapy before surgery.Results:Recurrence rates were 12% in the COP flap group and 60% in the conventional flap coverage group (P < 0.001). Results were compared at 16-month follow-up.Conclusions:The COP flap significantly reduces recurrences and eliminates shearing forces, suture ripping, and tension on superficial soft-tissue layers. The technique can be applied to both ischial and sacral pressure sores. The flap provides padding over bony prominence without jeopardizing flap vascularity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Gargano

Edstrom

Szymanski³

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

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“…For rotation flaps, the leading edge of the flap is one of the borders of the defect; the border of the flaps should be longer than the border of the defect by a ratio of 4:1 [40][41][42] (Fig. 3).…”

Section: Rotation Flapsmentioning

confidence: 99%

“…These can be combined in quadruple or double fashion. 46,47 This type of flap is also useful for sacral pressure sore coverage, 41 where it is best designed based on a perforator artery. 48 The flaps ultimately produce a long S-shaped incision that generally heals well (Figs.…”

Section: Ying-yang Flapsmentioning

confidence: 99%

Local Flaps, Including Pedicled Perforator Flaps

Maciel-Miranda

Morris

Hallock

2013

Plastic &Amp; Reconstructive Surgery

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The purpose of this article is to comprehensively review the topic of local flaps. Local flaps are those that are elevated nearby and then transferred to an adjacent wound. Options include geometric local flaps, axial pattern local flaps and a new exciting group of flaps, local perforator flaps. The principles, advantages, disadvantages, and applications for each are carefully analyzed. Local perforator flaps can be harvested virtually anywhere in the body and represent a significant clinical advance, as these can solve a wide variety of clinical challenges. These flaps do require gentle microsurgical dissection technique with careful handling for inset of the flap and simultaneously provide the same advantages of other types of local flaps because they also use nearby tissues with a similar color match, thickness, and texture, with primary donor-site closure possible. Local perforator flaps are another very useful option that undoubtedly will become more popular as more surgeons become more familiar with their use and advantages.

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Rotation flaps in the treatment of ischial pressure sores – the bigger the better

Cited by 2 publications

References 4 publications

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Local Flaps, Including Pedicled Perforator Flaps

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