The inferiorly based rectus abdominis myocutaneous flap for recurrent pelvic pressure sores in neurologically impaired patients

Abstract

The inferiorly based rectus abdominis myocutaneous flap, developed by Taylor, is a reliable flap which when raised spares the anterior sheath of the muscle below the arcuate line. The muscle can fill an infected, hypovascular wound and the extensive skin paddle can cover a large cutaneous loss of substance, so the flap is perfectly suited to coverage of recurrent pressure sores in paraplegic patients. We used 11 flaps in 10 paraplegic patients for recurrent pelvic pressure sores which were ischial in six cases, trochanteric in four and sacral in one. We describe the operative technique and stress the importance of using an extraperitoneal, intrapelvic and transiliac approach. Healing was obtained in all cases without functional deficit of the abdominal wall (no abdominal herniation, one contour deformity). This flap offers two further options for treatment of recurrent pelvic pressure sores whatever their location and its indications are more and more frequent in an aging population of paraplegic patients.