The Management of Decubitus Ulcers by Musculocutaneous Flaps: A Five-Year Experience

Mandrekas, Apostolos D.; Mastorakos, Dimitris

doi:10.1097/00000637-199202000-00007

Cited by 48 publications

(35 citation statements)

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“…Despite various surgical methods described in literature, the rate of recurrence is high. [1][2][3][4] Repeated recurrence of sores sometimes occurs in patients who pay no attention to instructions regarding pressure sores and in others who have treatment complications. Yamamoto et al 5 described a higher recurrence rate for ischial sores than for sacral sores.…”

Section: Discussionmentioning

confidence: 99%

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way

et al. 2010

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Methods: From 1995 to 1997, the authors used in 12 consecutive paraplegic patients, who had a grade III or IV decubitus ulcer in the ischial area only, two different and independent flaps coupled together in a 'criss-cross' musculocutaneous flap: a split-muscle gluteus maximus flap and a rhomboid fasciocutaneous local flap. The average follow-up period was 3 years and 9 months. Details of the operative procedure are presented to prove that this criss-cross closure of the ischial pressure sore beneficial for patients with spinal cord injury. Results: All flaps survived; recurrence of the decubitus ulcer occurred in one patient (8%). Pressuresore-free survival after surgery was 20 months in the patient with recurrence and an average of 26 months in patients without recurrence. Conclusion:The results obtained confirm this procedure to be safe and useful. We believe this technique to be a valuable alternative for the reconstruction of primary or recurrent ischial pressure ulcers.

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Section: Discussionmentioning

confidence: 99%

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way

et al. 2010

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“…Existing articles on PrU recurrence come primarily from the surgical literature, where the primary focus is on case studies and descriptions of surgical techniques. Recurrence rates of individuals whose ulcers were surgically treated have ranged from 11% to 29% in cases with postoperative complications and 6% to 61% in cases without postoperative complications (12,(24)(25)(26)(27)(28)(29)(30). Krause and Broderick (31) reported that 13% of their sample of 633 subjects with SCI had one or more recurrent PrUs per year.…”

Section: Introductionmentioning

confidence: 99%

Predictors Of Pressure Ulcer Recurrence In Veterans With Spinal Cord Injury

Guihan

Garber²,

Bombardier³

et al. 2008

The Journal of Spinal Cord Medicine

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Background/Objective: To predict recurrence of pressure ulcers (PrUs) in a high-risk population of veterans with spinal cord injury (SCI). Design: Cross-sectional observational design. Participants: A convenience sample of 64 subjects from 6 Department of Veterans Affairs (VA) SCI Centers who had been admitted to the hospital for the treatment of stage III-IV pelvic PrUs and were healed at the time of discharge back to the community. Main Outcome Measures: Primary outcome measures were pelvic PrU recurrence, defined as selfreported new skin breakdown (stage II or greater) in the pelvic area (not necessarily in the same location as previous ulcer) and time to recurrence. Results: There were no differences between those with/without recurrences with regard to age, age at/level of injury, number of previous ulcers or surgery, rate of or time, to recurrence. Mean age was 56 years; most were white and men, lived at home, and had some college education. Mean time since SCI was 22 years; 28% had tetraplegia; mean number of prior pressure ulcers was 3; and almost one half had a previous ulcer in the same location. The strongest predictor of recurrence in a multivariate logistic regression was African American race (odds ratio ¼ 9.3). Additional predictors included higher scores on the Charlson Co-Morbidity Index (indicating a higher burden of illness), the Salzburg PrU Risk Assessment Scales, and longer sitting time at discharge. Conclusion: Identifying individuals at highest risk for recurrence and developing effective prevention programs are essential rehabilitation goals. We recommend that the unique findings of this exploratory study be considered preliminary until replication of these results is published.

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“…Table 5 gives a menu of fl aps available for reconstruction to choose from. All fl aps are contraindicated if the general condition is poor, there is poor social support or if the patient is expected to be non-compliant with therapy hereafter [17,18].…”

Section: Surgery For Bedsoresmentioning

confidence: 99%

“…It has now been realized that unless the disease that lead to bedsores is cured, bedsores are likely to recur [17,19]. Table 5 Choice of fl aps available to provide skin-cover for bedsore 1 [17,18] 12 Like free radicals etc. 13 Food and drugs authority of USA 14 Human platelet derived growth factor…”

Section: Recent Advancesmentioning

confidence: 99%

Bedsores: “top to bottom” and “bottom to top”

et al. 2008

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Bedsore is a global problem concerning the bedridden, infi rm, debilitated and malnourished patients in hospitals and community setups. The cost of treatment is enormous involving billions of dollars to nations and individuals. Mortality increases two to six times if bedsores are present. There is little research done despite its commonness to understand how they occur or why they occur; etiology is not much understood. The two theories called 'top to bottom' and 'bottom to top'contradict each other. It is thought that 'pressure', shear-stress' and 'ischemia' may be causing it in some yet to be understood way.There is little awareness on how to prevent them or how to treat them if they do occur. Seldom applied, various scales exist and should be used to identify patients at high risk. Braden scale is the most tested and widely accepted scale. The various available dressings and pressure relief devices are mostly inadequately studied; which is superior is a question that begs an answer. This article aims to underline the importance of bedsores by reviewing our current and past knowledge with emphasis on practical implications thereof.

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The Management of Decubitus Ulcers by Musculocutaneous Flaps: A Five-Year Experience

Cited by 48 publications

References 0 publications

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way

Predictors Of Pressure Ulcer Recurrence In Veterans With Spinal Cord Injury

Bedsores: “top to bottom” and “bottom to top”

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