Managements of Sacral and Trochanteric Pressure Sores with Preoperative Topical Negative Pressure Therapy and Perforator-based Flap Surgery

Abstract

The treatment of pressure sores remains a thorny problem for plastic surgeons. Perforator-flap surgery, one of the advancements in microsurgical free tissue transfers, has become popular in recent years. We have used 12 perforator-based island pedicled flaps, including the superior gluteal artery perforator-based of sacral and trochanteric pressure sores from September 2002 to December 2003. The topical negative pressure therapy has been applied to all these wounds before the reconstructive procedures were carried out. Unfortunately, one patient died of airway obstruction in prone position postoperatively. The other flaps survived with minor complications in two cases. These minor complications were wound dehiscence and infection. Both cases were managed by antibiotic administration, debridement surgery, negative pressure therapy, and secondary wound closure without the need of additional flap surgery. Based on our experience, we have come to favor pedicled perforator-based flaps as the method for the reconstruction of sacral and trochanteric pressure sores, and advocate preoperative topical negative pressure therapy for wound care in improving the wound condition. This combined therapy is one of the best options for pressure sore reconstruction.