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The purpose of this report was to present the results of coverage of giant sacral sores with a gastrocnemius myocutaneous flap pedicled with femoral vessels after thigh amputation. Between June 1989 and April 2010, 10 patients with paraplegia having giant sacral pressure sores underwent early aggressive surgical debridement followed by surgical rec...
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Pressure ulcers are frequent complications for spinal-cord-injured patients and, trochanteric pressure sores, are quite difficult to treat. This site requires to consider some aspects, such as wound dimension, surgical timing, and reconstructive flap choice.
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Background
Many patients with decubitus-related osteomyelitis are ineligible for myocutaneous flapping, and optimal management in this population is unknown. We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage.
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Trochanteric pressure sores can be quite difficult to treat, especially in cases of large bone involvement requiring a wide debridement. The residual wound is large and deep, and the reconstruction must ensure a complete fill of all dead spaces, then must be covered with adequate tissue to allow for healing, and reduce the risk of recurrence.
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Citations
... Various surgical techniques have been described to repair complex stage IV pressure sores. 1,3,28,29 FIGURE 5. Intraoperative view of case 2, in the second operation. Left, Leg part of right lower-extremity fillet flap, which is remaining after sacrification of right plantar flap; also, a plantar flap with a long pedicle prepared from the left lower extremity. ...
Background
The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life.
Methods
We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap.
Results
No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month.
Conclusions
These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.
