Sheeja Rajan T. M1, Ranjith Satyan2, Sreelesh L. S3
BACKGROUND
Pressure ulcers can significantly contribute to morbidity and mortality by chronic infections. Radical debridement of all devitalised
and infected tissues followed by a reconstructive algorithm for soft tissue padding over bony prominences to prevent recurrent
breakdown are the mainstay of surgical management of pressure ulcers. Choice of the soft tissue flap for reconstruction is
influenced by the dimensions of ulcers, local tissue availability and surgeon’s preferences.
MATERIALS AND METHODS
This retrospective study includes 140 patients with spinal injuries having pressure ulcers of NPUAP grade III and IV treated
surgically over a period of four years. The demographics of pressure ulcers, the workhorse flap options as well as the outcome
were analysed.
RESULTS
The pressure ulcers were seen predominantly in males (93.6%) of 40-49 years’ age group (42.8%). Ischial pressure ulcers
(n=104) constituted 74.2% followed by sacral pressure ulcers (n=24) that is 17.1% and trochanteric pressure ulcers (n=12) in
8.6%. Debridement and direct closure of wound were possible only in 10 cases. Majority (92.8%) of patients needed additional
tissues for wound coverage. Our workhorse fasciocutaneous flaps were rotation flaps from the gluteal region or posterior thigh
with medial or lateral based designs (34.2%). Local muscle tissue was used in 64 cases (46%) either as gluteal, tensor fascia
lata and biceps femoris myocutaneous flaps or gluteus maximus, hamstring or gracilis muscle fillers in myoplasty.
CONCLUSIONS
Rotation flap along with myoplasty were our workhorse flap options in majority of the pressure ulcers. But, our future perspective
is to spare muscle and use more fasciocutaneous perforator flaps for reconstruction according to evidence-based clinical practice.
