Plastic surgery for closure of decubitus ulcers in patients with paraplegia: Based on experience with 1,000 cases

Abstract

1. 1. An analysis is presented of the results of the treatment of 600 decubitus ulcers in 345 patients with paraplegia during a five-year period (1950 to 1955). Conclusions in this report are based on experience with these cases and an additional 400 decubitus ulcers reported on previously from this hospital. Sixty-five per cent of the patients had ulcers. One hundred fifty-eight ulcers were recurrent, that is, they had been closed, but then reopened. Ulcers occurred in nineteen different sites. 2. 2. Surgery was the most satisfactory form of treatment. Three hundred forty-seven ulcers were treated surgically, a total of 415 operations being performed. 3. 3. Ischial, sacral and trochanteric ulcers made up 71 per cent of the total number and presented the greatest therapeutic challenge. 4. 4. The principles of surgical treatment found to be most successful were: (1) excision of the ulcer, surrounding scar, underlying bursa, and soft tissue calcification, if present; (2) radical removal of the underlying bone; (3) fascia or muscle flap to cover bone stumps and fill dead space; (4) coverage with a large regional pedicle flap of skin and fat; and (5) thick-split skin graft to cover the donor site of the flap. 5. 5. Using this technic, the success of surgery, that is, the percentage of ulcers which healed and did not recur, was increased to 97 per cent for ischial ulcers, 86 per cent for trochanteric ulcers and 84 per cent for sacral ulcers. The recurrence rate following surgery was 3 per cent for ischial ulcers, 6 per cent for trochanteric ulcers and 11 per cent for sacral ulcers. 6. 6. The pathology, general treatment, surgical treatment and the complications of decubitus ulcers in paraplegic patients are discussed.