The operative treatment of pressure wounds: a 10‐year experience in flap selection

Abstract

This study sought to both assist in the selection of flaps for ischial pressure wound reconstruction and evaluate the overall complication rates associated with reconstruction. A retrospective medical record review was conducted for 78 patients following the surgical reconstruction of an ischial pressure sore. Records were reviewed for demographics, location of sores, methods of reconstruction and flap selection, as well as any complications and recurrences. A total of 72 wounds were reconstructed with an average of 1.4 flaps used per wound. An ischial flap complication rate of 16% was observed in flap follow-up, with a recurrence rate of 7% recorded. The vast majority of complications went on to heal with 15% of patients requiring a second reconstruction. Our relatively large sample of ischial flaps allowed for a close comparison with previously published work. Both flap selection and site of reconstruction significantly affected the success rates for pressure sore coverage. The overall complication rates by flap and reconstructive site in this review are lower than previously published reports. Our experience with ischial reconstruction was extensive enough to suggest a posterior medial thigh fasciocutaneous flap combined with a biceps femoris muscle flap as a first choice in ischial pressure wound reconstruction.

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

“…Alhuwalia et al published a complication rate of 16% in 104 skin flaps. 17 Another study from Srivastava et al observed a rate of complications of 16.6% in 25 patients with 39 pressure ulcers. 20 Authors had a much lower number of cases treated than we did, and did not describe how they defined complications.…”

“…The scientific literature points to specific factors in flap surgery that cause complications such as the separation of the flap from primary blood sources, temporary reduction in circulation and expansion of wound areas during surgery. 10,[16][17][18][19] The localization of pressure ulcers influences the appearance of complications, probably due to positioning and care of the ulcer following surgery. Researchers have documented the rate of complications according to pressure ulcer reconstruction localizations, and show varying results.…”

The Combination Application of Space Filling and Closed Irrigation Suction in Reconstruction of Sacral Decubitus Ulcer

“…However, muscle flap with good blood supply, strong anti-infection capability, filling the dead space entirely and preserving the structure integrity was usually a better option for repairing a decubitus ulcer. [15][16][17] Decubitus cavities at the ischial tuberosity of the bedsore wound are often bigger, most already invading the gluteus maximus under the gap, and even invading the hip joint. At this time, repair of the ischial tuberosity decubitus through transferring the gluteus maximus flap may influence repair effect.…”

“…A large cavity will lead to poor drainage, which will increase infection and lead to operation failure. [3][4][5] Closed irrigation combined with space filling can effectively obliterate the dead space and produce full drainage. However, there have been no reports concerning the use of these two methods simultaneously for 24 hours.…”

Application of Split Gluteus Maximus Muscle–Adipofascial Turnover Flap and Subcutaneous Tension-Reducing Suture Technique in Repair of Decubitus Ulcers

“…Dead space after resection of decubitus ulcer easily causes serious postoperative complications such as infection, fistula formation, and bowel obstruction. [1][2][3] Coincidentally, patients with decubitus ulcers are usually more likely to suffer from poor health. A simple and reliable reconstructive technique to fill the defect is therefore preferable.…”