Sacral Pressure Sores Research Articles

筋皮弁を用いたじょくそうの治療について（骨盤周囲のじょくそうを中心に）

Despite emphasis on prevention, pressure sores continue to occur and prevent these patients from functioning in society. It is important to evaluate the extent of the lesion correctly and to make treatment programs. We have managed sacral, trochanteric and ischial pressure sores by the use of musculocutaneous flap. A total of 12 musculocutaneous transpositions have been done for the last 4 years. This experience will be reviewed.

The long-term management of sacral, ischial and trochanteric pressure sores by Myocutaneous Island flaps and their postoperative course

Thirty-three patients, mostly paraplegics, were treated for chronic pressure sores Campbell stages IV–VI overlying the sacrum, the ischial tuberosity and the femoral tuberosity. A stable, multi-layered cover of the defect, following excision of the decubiti, could be achieved in one stage using single myocutaneous gluteus maximus and biceps femoris island flaps or, when indicated, a combination of both. The postoperative complication rate was 7/65 (65 myocutaneous flaps were used in 33 patients) or 10.8%. Except for one recurrence due to a traumatic hematoma causing subtotal, external compression of the axial vascular pedicle and consequent partial necrosis of the myocutaneous island flap, all other flaps provided adequate closure and padding. They provided durable cover over a mean follow-up period of 25 months. These results are compared with the relevant literature.

The gluteus maximus musculocutaneous island flap: refinements in design and application.

The gluteus maximus island musculocutaneous flap has been described using a variety of designs. We employ an island whose long axis is directed toward the pressure sore, minimizing tension in wound closure. Skin overlying the greater trochanter is avoided. Previously undermined skin can be included in the flap. Fifty patients with ischial or sacral pressure sores have been managed by this technique. Superficial dehiscence occurred in 13 percent of patients, and deep dehiscence occurred in 10 percent. The dehiscence closed spontaneously in all but one patient. Forty-nine of the 50 patients experienced complete wound healing at the pressure sore site. The patients have been observed for an average of 20 months (range 3 to 38 months), with one recurrent pressure sore seen at 28 months postoperatively. The gluteus maximus musculocutaneous island flap has proven to be both reliable in healing and durable over the observed interval.

Gluteus Maximus Myocutaneous Flaps for Repair of the Sacral Pressure Sores

Gluteus Maximus Myocutaneous Flaps for Repair of the Sacral Pressure Sores

Experience with the gluteus maximus musculocutaneous V-Y advancement flap for sacral pressure sores. (Japanese)

Experience with the gluteus maximus musculocutaneous V-Y advancement flap for sacral pressure sores. (Japanese)

The gluteus maximus musculocutaneous flap as bilateral V-Y sliding flap or as pendulum flap for closure of sacral and ischial pressure sores

Eight V-Y and fourteen pendulum gluteus maximus myocutaneous flaps have been used in eighteen patients for closure of sacral and ischial pressure sores. The patients have been followed-up for between 3 and 36 months and there was only one recurrence in a patient who had had a bilateral pendulum flap. There has been no functional impairment in the ambulant patients.

Experiences of V-Y Advancement Flap Method in Sacral Pressure Sores

In 1982, Michael Scheflan et al. Introduced bilateral gluteus maximus musculocutaneous island transposition flap for the closure of sacral ulcers. This flap is based on the superior gluteal pedicle and have a superior half of gluteus maximus with the overlying skin. After the coverage of the skin defect by sliding this flap medially, the skin donor site is closed in a V-Y advancement manner. Our experiences in 6 operations with this unilateral gluteus maximus flap showed no recurrence except 1 case whose ulcer was largest in 6 cases. All patients were unable to walk preoperatively and postoperatively. We have no experience of other gluteus maximus flap but this method seems to be easy technically and safe.

Thoracolumbar-Sacral Flaps in the Treatment of Sacral Pressure Sores

The treatment of pressure sores is a challenging problem. A new flap is described to be added to the armamentarium of surgeons looking after these patients. This procedure is not presented as a panacea for the sacral pressure sores but as an additional technique that could be used in very large sacral pressure sores, particularly recurrent pressure sores following conventional procedures.

Further Experience with the Tensor Fascia Lata Musculocutaneous Flap

We have found the tensor fascia lata myocutaneous flap to be exceedingly reliable with a consistent vascular pedicle; it can be elevated easily and rapidly in its subfascial plane. It is a useful flap in the paraplegic patient for closure of ischial, trochanteric, and sacral pressure sores, and may also be used as a free flap with little donor morbidity. At present, we recommend this as the flap of choice for closure of trochanteric pressure sores. Additionally, it appears to have further applications in defects of the groin, perineum, abdominal wall, and lower chest wall. Eleven tensor fascia lata musculocutaneous flaps, utilized for soft tissue coverage for varying defects in 9 patients, are discussed.

Further Experience with the Tensor Fascia Lata Musculocutaneous Flap

We have found the tensor fascia lata myocutaneous flap to be exceedingly reliable with a consistent vascular pedicle; it can be elevated easily and rapidly in its subfascial plane. It is a useful flap in the paraplegic patient for colsure of ischial, trochanteric, and sacral pressure sores, and may also be used as a free flap with little donor morbidity. At present, we recommend this as the flap of choice for closure of trochanteric pressure sores. Additionally, it appears to have further applications in defects of the groin, perineum, abdominal wall, and lower chest wall. Eleven tensor fascia lata musculocutaneous flaps, utilized for soft tissue coverage for varying defects in 9 patients, are discussed.

THE TRANSVERSE LUMBOSACRAL BACK FLAP

The transverse lumbosacral back flap is presented as a good one to use for coverage of sacral defects. Its reliability appears to be due to an axial pattern of its proximal portion, and to an uninterrupted subdermal vascular plexus across the midline of the back (supplying the terminal portion). A retrospective analysis of its use in 20 patients, over the last 3 years, suggests that when it is designed properly it can be most useful in the management of sacral pressure sores.

V–Y advancement gluteus maximus fasciocutaneous flap—A useful flap for sacral defects

Introduction: This study was done to evaluate the usefulness of V–Y advancement gluteus maximus fasciocutaneous flap in the management of sacral defects. Material and methods: A total of 15 patients with sacral defects either due to sacral pressure sores or defects following excision of sacral soft tissue tumors were treated using this technique in a single stage. The size of the defect and postoperative complications in each patient were assessed. The follow-up period was a minimum of 1 year. Results: All wounds healed with no recurrence. During follow-up, two patients had wound healing problems with wound discharge which healed with dressings within 2 months. Conclusion: The use of V–Y advancement gluteus maximus fasciocutaneous flap offers an easy and safe flap in sacral defect reconstruction.