ISCHIAL PRESSURE SORE COVERAGE - A RATIONALE FOR FLAP SELECTION

The role of wound debridement and flap coverage in treating pressure s ores is clearly established. However, criteria and supportive clinical data for specific flap selection and the sequence of flaps for covera ge of the ischium remain ill-defined. From 1979-1995, 114 consecutive patients underwent flap coverage of 139 ischial pressure sores. Preope rative risk factors, prior flap history, defect size, flap success, co mplication rates, and the length of hospitalization were retrospective ly evaluated and compared for 112 flaps in 87 patients. Flap success w as defined as a completely healed wound. Average follow-up was 10 mont hs (range: 1 month-9 years). Overall, 83% (93/112) of the flaps healed . In the majority of cases (75%, 84/112), wound debridement and flap r econstruction was achieved in a single stage. However, there were sign ificant differences in the healing rates among the various flaps used. The inferior gluteus maximus island flap and the inferior gluteal thi gh flap had the highest success rates, 94% (32/34) and 93% (25/27), re spectively, while the V-Y hamstring flap and the tensor fascia lata fl ap had the poorest healing rates, 58% (7/12) and 50% (6/12), respectiv ely. Flap success was not significantly affected by the age of the pat ient or the prior number of flaps used and preoperative risk factors w ere equally distributed across all types of flaps. The overall complic ation rate was 37% (41/112), most commonly from a slight wound edge de hiscence (n = 16) that healed with local wound care within one month p ostoperatively. Results of this study show that proper flap selection and the appropriate sequence of flap use significantly improve success rates for ischial pressure sore coverage in both the short- and long- term. Based upon flap reliability (successful healing rates), reusabil ity, and the need to preserve as many future flap options as possible, a rationale for flap selection is presented which can be individualiz ed to any patient.