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Ischial pressure sores can be efficiently covered with a modification of the traditional V-Y advancement flap, the musculocutaneous hatchet flap. Results of operations performed on 10 patients prove its reliability.

One of the most frequently used flaps for the coverage of sacral skin and soft-tissue defects (primarily decubiti) is the gluteus maximus musculocutaneous flap. The authors have developed a new, hatchet-shaped incision direction for the flap and have been using it for 6 years in the surgical treatment of various pelvic-area defects with good results. At the beginning, the gluteus maximus hatchet-shaped flap was used for treatment of pressure sores in the pelvic area: sacral decubitus on 31 patients, ischial pressure ulcer on 12 patients, and trochanteric ulcer on 1 patient. However, later the method was applied to nondecubitus defects, such as myelomeningocele on 4 patients, Crohn disease on 3 patients, pilonidal sinus on 2 patients, and traumatic defect on 1 patient, totaling 71 flaps on 54 patients. The seroma (4), hematoma (2), postoperative bleeding (1), and partial flap necrosis (1) healed following emptying and repeated surgery; recurrent ulcer was seen in 2 cases. Advantages of the method are the fewer incisions needed, the shorter operating time, and the smaller blood loss as compared with the methods known so far. The new incision direction improves the safety of circulation in the flap, the closure of the donor site is simpler, and no contour difference remains in the surgical area.

Context: Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. Methods: A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. Results: We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. Conclusion:The strict adherence to surgical indications, full patient compliance, specialized pre-and postoperative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

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