Pelvic pressure ulcer reconstructions by pedicled muscle flaps

Abstract

Introduction: Pelvic region is the most predisposed topographic area of the body to pressure ulcers in immobile patients. This communication presents the experience of the authors and set to discussion the value of the pedicled muscle flaps in the management of pressure ulcers stage III and IV. Material and Methods: The study was conducted during the period from May 2006 to December 2014. A total of 11 muscle based flaps were applied on 5 male and one female patients with deep pressure ulcers in the pelvic region. Musculus gluteus maximus (MGM), musculus gracilis (MG), musculus hamstring (MH), musculus vastus lateralis femoris (MVLF) and musculus rectus abdominis (MRA) were designed as monocomponent muscle or compound skin-muscle flaps in accordance with the wound characteristics. Results: The patients were followed-up from 1 month to 6 years. All flaps were vital. Small area partial skin necrosis of the MRA flap and MH advancement flap required secondary surgical procedures within a month after the reconstruction. Four recurrences through variable periods were observed in one patient, operated on by different muscle flaps. Conclusion: Pressure ulcers are a frequent complication in immobile patients. Surgery is the most effective treatment method for wounds at stages III and IV. Patient’s general condition and wound status should be taken into consideration when planning the reconstruction. The vitality and volume of the muscle flaps are the main advantages of that alternative for surgical treatment of pelvic pressure sores.