K. Warbanow et al., MYOCUTANEOUS FLAPS AS SAFE DEFECT COVERIN G OF HIGH-GRADE PELVIC PRESSURE SORES, Langenbecks Archiv fur Chirurgie, 382(6), 1997, pp. 359-366
Infected pelvic pressure sores of Campbell stages IV-VII require soft
tissue reconstruction, which means stable, multi-layered filling cover
of the defect and reliable prophylaxis of relapse. Myocutaneous flaps
meet these conditions well. Depending on the extent and the area of t
he sore, with predilection for the sacrum, the ischial tuberosity and
the femoral trochanter. the gluteus maximus. biceps femoris and tensor
fasciae latae muscles are most often used for myocutaneous flaps. Pri
mary sutures, split skin grafts or local fasciocutaneous flaps are oft
en sufficient treatment for smaller, superficial defects. Between 1981
and 1996, 133 patients (average age 50 years) with 212 pelvic pressur
e sores of all stages were treated in our clinic. After radical decubi
tus excision with pseudotumor technique and resection of the osseous p
rominences, one-stage reconstruction of solitary as well as multiple d
efects was performed with myocutaneous flaps in 135 cases. The postope
rative general complication rate for all treatments was about 10-30%.
With regard to the muscle flaps, one third healed without any problems
, partial flap necrosis occurred in 6% and there was total loss of fla
p in 2% of all myocutaneous flaps. According to present knowledge, myo
cutaneous flaps seem to be the most reliable method for definitive cov
ering of deep pelvic pressure sores, independent of the cause of the u
lcer.