Complex reconstructive surgery for a recurrent ischial pressure ulcer with contralateral muscle

Abstract

The management of recurrent pressure ulcers is a frequent problem in patients with spinal cord injuries. Many local muscle and fasciocutaneous flaps can be used to cover ulcers of all sizes. However, when a recurrent pressure ulcer has been repeatedly addressed, the number of available flaps becomes quite limited. Contralateral muscles, such as the gracilis, can be used to cover recurrent ischioperineal ulcers and should be employed before last resort surgeries, such as hip disarticulation and the total thigh flap.

Keywords

Pressure ulcer / recurrent / gracilis / muscle / contralateral

References

[1] Marin J,Gorecki C.A systematic review of risk factors for the development and recurrence of pressure ulcers in people with spinal cord injuries..Spinal Cord2013;51:522-7

[2] Kruger EA,Ngann Y,Rubayi S.Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends..J Spinal Cord Med2013;36:572-85 PMCID:PMC3831318

[3] Gunnewicht BR.Pressure sores in patients with acute spinal cord injury..J Wound Care1995;4:452-4

[4] Bamba R,Hoffman AN,Thayer WP,Spear ME.Flap reconstruction for pressure ulcers: an outcomes analysis..Plast Reconstr Surg Glob Open2017;5:e1187 PMCID:PMC5293292

[5] Keys KA,Warner KJ.Multivariate predictors of failure after flap coverage of pressure ulcers..Plast Reconstr Surg2010;125:1725-34

[6] Chiu YJ,Wang TH,Ma H,Wu SH.A retrospective study: multivariate logistic regression analysis of outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous, and perforator flaps..J Plast Reconstr Aesthet Surg2017;70:1038-43

[7] Rubayi S.Trunk, abdomen, and pressure sore reconstruction..Plast Reconstr Surg2011;128:e201-15

[8] Rubayi S.Reconstructive plastic surgery of pressure ulcers..2015;New YorkSpringer

[9] Cheng PTY,Chunilal A.Modified total thigh musculocutaneous flap: 'operation of last resort' for massive pressure ulcers..J Plast Reconstr Aesthet Surg2014;67:260-3

[10] Berger SR,Griffin AC.Closure of multiple pressure sores with split total thigh flap..Ann Plast Surg1994;33:548-51

[11] Yusmido YA,Mazian M.Elective proximal lower limb amputation in spinal cord injury patients with chronic pressure ulcers: improve quality of life, function, and shorten hospital stay..Eur J Phys Rehabil Med2014;50:557-60

[12] Patel AC.Coverage of an ischial pressure ulcer with an interpolated contralateral posterior thigh fasciocutaneous flap..Br J Plast Surg2001;54:547-9

[13] Kierney PC,Engrav LH,Rand RP.Limb-salvage in reconstruction of recalcitrant pressure sores using the inferiorly based rectus abdominis myocutaneous flap..Plast Reconstr Surg1998;102:111-6

[14] Lee SS,Chen MC,Lai CS.Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap..J Plast Reconstr Aesthet Surg2009;62:1339-46

[15] Evans GR,Manson PN,Vander Kolk CA.Hip joint communication with pressure sore: the refractory wound and the role of Girdlestone arthroplasty..Plast Reconstr Surg1993;91:288-94

[16] Rubayi S,Kruger E.The modified Girdlestone procedure with muscle flap for management of pressure ulcers and heterotopic ossification of the hip region in spinal injury patients: a 15-year review with long-term follow-up..Ann Plast Surg2016;77:645-52