CLOSURE OF MULTIPLE PRESSURE SORES WITH SPLIT TOTAL THIGH FLAP

Pressure sores remain a pervasive and recurrent problem in the chronic ally bedridden and immobilized insensate patient populations, such as those with spinal cord injury. Various musculocutaneous flaps based on muscles of the buttock and thigh are routinely used to close primary, uncomplicated ulcers. The gluteus maximus, tenser fascia lata, and po sterior thigh muscles, for example, can be used to close the majority of primary defects. In the case of extensive and recurrent ulceration, however, particularly when the hip joint or proximal femur is infecte d or marked heterotopic ossification is present, these conventional fl aps are inadequate. The total thigh flap offers a solution to some of these problems by providing a large volume of tissue as a unit to cove r the defects, particularly in cases in which other reconstructive opt ions have been exhausted. We describe a modification in the total thig h flap procedure by splitting the flap according to its vascularity to achieve closure of multiple pressure ulcers in a one-stage procedure.