[Primary immediate coverage of decubitus ulcers by musculocutaneous flaps and gentamicin PMMA beads]

Myo- or fasciocutaneous flaps for coverage of longstanding pressure sores in para- or quadriplegic patients have been proved superior to cutaneous flaps. Pretreatment with ulcer-debridement and systemic antibiotics for urinary-tract-infection and septicaemia was thought to be necessary for successful closure of these difficult defects. In a prospective, clinical trial 17 patients with 20 pressure sores were treated this way during 1980-1983. From 1983-1985 no local or antibiotic treatment was given to a second group of 20 patients with 28 decubitus ulcers prior to a one-stage-closure of the pressure sores. Only five patients with septicaemia above 39 degrees C received antibiotics intraoperatively. Gentamicin-PMMA-beads were temporarily inserted under the myo- or fasciocutaneous flaps during the procedure. If necessary, urinary-tract-infection was treated after successful coverage. Both groups have been compared historically. There were less wound complications in the second group while a median time-saving of 2 1/2 weeks per patient could be gained, even though they had larger pressure sores, frequent bone involvement, and multiple ulcers in this group.