LIMB-SALVAGE IN RECONSTRUCTION OF RECALCITRANT PRESSURE SORES USING THE INFERIORLY BASED RECTUS-ABDOMINIS MYOCUTANEOUS FLAP

Pressure sore closure is frequently a reconstructive challenge. This c hallenge is particularly evident in cases of multiply recurrent sores. In such settings, there are often opportunities to manage the recurre nt wounds either by repeated advancement of previous flaps or by desig n of alternative ones. However, these interventions are not always fea sible, and limb amputation with total thigh flap closure must be consi dered. A review of operative experience with seven such complex pressu re sores in seven patients is presented. Each patient had previously s uffered a permanent thoracic-level spinal cord injury. Prior attempts at wound closure were unsuccessful. Despite consideration of all descr ibed locoregional flaps, no limb-sparing procedure could be designed s atisfactorily. As an alternative to either hip disarticulation and tot al thigh flap coverage or distant fi ee-tissue transfer, we reconstruc ted the debrided ulcer beds with inferiorly based rectus abdominis myo cutaneous flaps. Sis of the seven wounds healed primarily, whereas one required repeated debridement and the addition of a gracilis muscle f lap, to achieve complete closure. Postoperative follow-up has ranged f rom 6 to 45 months. Each patient has returned to his baseline preopera tive activity level with no clinical compromise of abdominal wall func tion. All wounds have healed. Successful application of the inferiorly based vertical rectus abdominis myocutaneous flap for cases of both r ecalcitrant ischial and trochanteric pressure sores is demonstrated an d its consideration is advocated if no reconstructive options short of extremity amputation and total thigh flap coverage exist for such cha llenging sores.