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Volumetric Evaluation of Dead Space in Ischial Pressure Injuries Using Magnetic Resonance Imaging: A Case Series
Dong Gyu Kim1, Eun Soo Park, Seung Min Nam
1In the Department of Plastic and Reconstructive Surgery at the Soonchunhyang University Bucheon Hospital in Bucheon, Republic of Korea, Dong Gyu Kim, MD, is Resident; Eun Soo Park, MD, PhD, is Professor and Chief of the Medical Department; Seung Min Nam, MD, PhD, and Chang Yong Choi, MD, PhD are Associate Professors; and Han Gyu Cha, MD, is Assistant Professor. Acknowledgments : This work was supported by the Soonchunhyang University Research Fund. The authors have disclosed no other financial relationships related to this article. Submitted October 16, 2020; accepted in revised form January 26, 2021.
Objective:
To establish a preoperative evaluation procedure by measuring the volume of dead space using MRI in patients with ischial pressure injuries.
Methods:
Patients with spinal cord injury and ischial pressure injuries who underwent treatment between August 2016 and November 2019 were included in the study. Preoperative MRI scan was conducted on all patients. The volume estimation and three-dimensional (3D) reconstruction were performed based on MRI data using a 3D Slicer. Based on the resulting volume, a muscle flap that could fit the dead space was selected. Surgery was performed with the selected muscle flap, and a fasciocutaneous flap was added, if necessary.
Results:
A total of eight patients with ischial pressure injuries were included in the study. The mean patient age was 59.0 ± 11.0 years. The mean body mass index was 26.62 ± 3.89 kg/m2. The mean volume of dead space was 104.75 ± 81.05 cm3. The gracilis muscle was the most selected muscle flap and was used in four patients. In five of eight cases, a fasciocutaneous flap was used as well. The mean follow-up period was 16 months, and by that point, none of the patients evinced complications that required surgery.
Conclusions:
To the authors' knowledge, this is the first report on volumetric evaluation of dead space in ischial pressure injuries. The authors believe that the 3D reconstruction process would enable adequate dead space obliteration in ischial pressure injuries. The authors propose that preoperative MRI scans in patients with ischial pressure injury should become an essential part of the process.
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