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Flap selection as a determinant of success in pressure sore coverage
R D Foster1, J P Anthony, S J Mathes
1Division of Plastic and Reconstructive Surgery, University of California at San Francisco, USA.
Objective:
To establish a treatment algorithm for the long-term surgical management of pressure sores.
Design:
Retrospective case series.
Setting:
University-based teaching hospital.
Patients:
From March 1979 to July 1995, 280 unselected pressure sore reconstructions (113 ischial, 94 sacral, and 73 trochanteric sores) were performed in 201 patients (130 men and 71 women; age range, 16-90 years; mean, 50 years). Of the patients, 90% had severe spinal cord injuries (paraplegia or quadriplegia). Forty-one percent of the wounds were chronic (present longer than 3 months).
Main Outcome Measures:
Length of stay, postoperative morbidity and mortality, and flap success (defined as a completely healed wound).
Results:
Overall, 89% of the flaps healed primarily (ischium, 83% [94/113]; sacrum, 91% [86/94]; trochanter, 93% [68/73]). Three fourths of cases were treated in a single stage (debridement and reconstruction). The inferior gluteus maximus island flap (ischium) (94% [32/ 34]), the V-Y gluteus maximus advancement flap (sacrum) (97% [36/37]), and the tensor fascia lata flap (trochanter) (95% [42/44]) had the highest success rates. Flap success was not significantly affected by the size of the pressure sore or the number of previous flaps used. Postoperative hospital stays averaged 20 days. The overall complication rate was 28%, most commonly from a slight wound edge dehiscence.
Conclusions:
Flap selection and the appropriate short- and long-term sequence of flap use significantly improve success rates for pressure sore coverage. Reconstruction can be reliably performed in a single stage with a relatively short hospitalization.