[Surgical treatment of decubitus ulcers]

In spite of the improved quality of medical care for paraplegic patients, patients with multiple sclerosis or spinal injuries after severe trauma, the incidence of pressure sores has not diminished. Whilst superficial ulcers usually heal with conservative treatment, deep established pressure sores rarely heal satisfactorily without surgical intervention. The various surgical procedures for closure of decubitus ulcers with their classical localisation, i. e. sacral, trochanteric and ischial ulcers, are critically discussed. The myocutaneous flaps offer a wide range of choices for coverage. Sometimes, however, it may be difficult to provide a good quality myocutaneous flap at one operation. In this paper 400 patients with extensive bed sores operated upon during the last 20 years in the Clinic for Plastic Surgery in Cologne, applying the "slide-swing plasty" are reported. Some principles of the slide-swing plasty are to be respected: The flap should be tailored to the size and the shape of the skin defect. Three basic forms of the method can be applied. The flap is placed to exploit the skin reserves surrounding the defect. The flap thickness should extend as far as the muscles. The advantages of this method are as follows: Extensive bed sores can be closed. Sometimes two or three ulcers can be dealt within a single operation. Subsequent recurrences can be closed again using slide-swing plasty.