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

This study sought to both assist in the selection of flaps for ischial pressure wound re-construction and to evaluate the overall complication rates associated with re-construction. A retrospective medical record review was conducted for 78 patients following the surgical re-construction of an ischial pressure sore. Records were reviewed for demographics, location of sores, methods of re-construction and flap selection, as well as any complications and recurrences. Seventy-two wounds were re-constructed 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 re-construction. 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 re-constructive site in this review are lower than previously published reports. Our experience with ischial re-construction 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 re-construction.