Reconstructive surgery in paraplegia

Abstract

Summary Because of improved medical and surgical care. paraplegics can look to the future with confidence. Their care is a group endeavor. with each specialist playing an important role in the patient's rehabilitation. The routine care of these patients consists primarily of cleanliness of the skin and decubitus ulcers. good nutrition. prevention of urinary tract complications and physiotherapy. The detailed regimen used to maintain these patients during the surgical phase of their rehabilitation has been outlined herein. The most common sites for ulcers are the sacral. ischial and trochanteric regions. A retrograde pedicle flap. based on the gluteal circulation. is the one of choice for resurfacing sacral ulcers. The transverse flap elevated above the ulcer on the back seems to be better for some large sacral decubitus ulcers. Because of the increased incidence of ischial ulcers as the patient assumes the sitting position. the resection of the ischial bursa, tuberosity and adjacent bones as a prophylactic measure in paraplegics seems to be justified. Following the resection of any ischial ulcer. primary repair should be performed if possible. A retrograde flap raised on the anterolateral aspect of the thigh is chosen to close a trochanteric ulcer. The base of the flap. rather than a skin graft. then lies under the brace. The plastic surgeon is constantly striving to improve his technic for keeping the skin surface intact. enabling the paraplegic to become ambulatory. care for himself, and often make a real contribution to society.