Our experience in treatment of pressure ulcers by using local cutaneous flaps

Pressure ulcers appear in very ill patients and in states of prolonged immobilization. They are quite frequent in intensive care units and in paraplegic individuals. The expenses for their sanation are huge, due to the complicity of the long-lasting treatment. Shallow and superficial pressure ulcers are treated conservatively. Deep ones, with expressive underlying bone prominence in which no regression is on-going, are better to be treated operatively, if possible. Thus the hospitalisation period and the need for frequent dressings are shortened, preventing enormous scars (sanatio per secundam intentionem of the wound) and the risk of subsequent infection. What is also important for the treatment of the prime disease is that the patient can rehabilitate earlier. There are many methods of excision of the ulcer, ablation of the bone prominence and coverage of the defect with different types of flaps afterwards. Although muscle flaps can be utilized, we assume that their use additionally influences the general condition of the patient (malnutrition and anaemia always co-exist). Thus we find our way of treatment less traumatising and better, if pliable, for decubital ulcers. The objective of the study was to evaluate the clinical results after an operative treatment of deep decubital ulcers (III and IV grade) with local dermal flaps and to promote the method of their closure. We paid special attention to ablation of the bone prominence. We used local pivotal adipose-cutaneous flaps in order to cover the cleansed tissue defect. The types of flaps employed were unilateral and bilateral rotation flaps, transposition and bipedicular flaps. Our series covered 23 patients who were operated on in the last 10 years, of whom 16 (69.6%) had a spinal cord injury (paraplegic). Pressure ulcers in the sacral region dominated with 12 cases (52.2%). The operative techniques that we used were as follows: unilateral rotation flaps (in 7 patients), bilateral rotation flap (in 1 patient), transposition flaps (in 10 patients), bipedicular flaps (in 2 patients), free skin Thiersch auto-transplant (in 2 patients) and direct closure of the defect (in 1 patient). The results advocate the justification of these ways of treatment of pressure ulcers, with few early and late complications.