Treatment of complex ischial pressure sores with free partial lateral latissimus dorsi musculocutaneous flaps in paraplegic patients

Abstract

In paraplegic patients dependent on their upper body for mobility, the latissimus dorsi muscle is generally unacceptable for microsurgical reconstruction of complex ischial defect. To avoid total muscle function loss, a portion of the lateral latissimus dorsi musculocutaneous flap can instead be harvested. From February 1999 to March 2009, 11 paraplegic patients with complex ischial pressure sores were prospectively recruited. The reconstruction was performed using a free partial lateral latissimus dorsi musculocutaneous flap. The follow-up period ranged from 18 to 114 months (mean, 60 months). All flaps survived postoperatively. No recurrence occurred in our series. All patients experienced various degrees of back tightness, shoulder weakness and limited shoulder motion since surgery, which were relieved within 9 months. The free partial lateral latissimus dorsi musculocutaneous flap can be a good alternative for covering severe infected ischial defect. Shoulder functional deficits will lessen over time and normal function will be regained gradually.