Reconstruction of Ischial Pressure Sore-A Review of a 10-year Experience in a Single Institute

Abstract

Background: The ischial pressure sore is associated with pressure in the sitting position. The roles of surgical debridement and flap reconstruction are well-established. However, most of the patients are young and paraplegic, and the recurrence of their pressure ulcers is an important issue during their lifetime. Aim and Objectives: This study provides our experiences in the reconstruction of ischial pressure sores. Based on these results, we propose a rationale for flap selection in the reconstruction of ischial pressure sore. Materials and Methods: From April 1999 to March 2009, there were one hundred and twenty-six ischial pressure-sore patients operated on at Kaohsiung Medical University Hospital. Forty patients underwent reconstructive flap surgery for definitive wound closure. Thirty-two patients (twenty-one men and eleven women) with long-term follow-up data were included in this study. A total of sixty flap operations were performed during the period. We categorized the transferred flaps into three groups: fasciocutaneous flap, myocutaneous or muscle flap, and combination of fasciocutaneous and muscle flaps. Ulcer-free survival rate was analyzed using the Kaplan-Meier method. Results: The recurrence was recognized in thirty of sixty pressure sores (50%). The period of recurrence ranged from three months to seventy months with a mean of 25.3 months. The fasciocutaneous flap had better survival in early follow-up. However, the myocutaneous and muscle flaps have comparative survival to that of the fasciocutaneous flap over long periods. The combined fasciocutaneous and muscle flap achieved better pressure sore-free survival in the patients with recurrent ischial pressure sore. Conclusion: Based on these results and experiences, we present our rationale for flap selection. The perforator-based fasciocutaneous flap is the initial choice of reconstruction. The muscle or myocutaneous flap can be used in the condition of recurrence. The combined fasciocutaneous and muscle flap (combined gracilis muscle flap and V-Y profunda femoris artery perforator-base flap) is suggested for reconstruction of intractable recurrent ischial pressure sores.