title: Limb-salvage in reconstruction of recalcitrant pressure sores using the inferiorly based rectus abdominis myocutaneous flap.
abstract: Pressure sore closure is frequently a reconstructive challenge. This challenge is particularly evident in cases of multiply recurrent sores. In such settings, there are often opportunities to manage the recurrent wounds either by repeated advancement of previous flaps or by design of alternative ones. However, these interventions are not always feasible, and limb amputation with total thigh flap closure must be considered. A review of operative experience with seven such complex pressure sores in seven patients is presented. Each patient had previously suffered a permanent thoracic-level spinal cord injury. Prior attempts at wound closure were unsuccessful. Despite consideration of all described locoregional flaps, no limb-sparing procedure could be designed satisfactorily. As an alternative to either hip disarticulation and total thigh flap coverage or distant free-tissue transfer, we reconstructed the debrided ulcer beds with inferiorly based rectus abdominis myocutaneous flaps. Six of the seven wounds healed primarily, whereas one required repeated debridement and the addition of a gracilis muscle flap to achieve complete closure. Postoperative follow-up has ranged from 6 to 45 months. Each patient has returned to his baseline preoperative activity level with no clinical compromise of abdominal wall function. All wounds have healed. Successful application of the inferiorly based vertical rectus abdominis myocutaneous flap for cases of both recalcitrant ischial and trochanteric pressure sores is demonstrated and its consideration is advocated if no reconstructive options short of extremity amputation and total thigh flap coverage exist for such challenging sores.
authors.affiliation: University of Washington Medical Center, Department of Surgery, Seattle, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Kierney
authors.forename: D D
authors.initials: DD
authors.lastname: Cardenas
authors.forename: L H
authors.initials: LH
authors.lastname: Engrav
authors.forename: J H
authors.initials: JH
authors.lastname: Grant
authors.forename: R P
authors.initials: RP
authors.lastname: Rand
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000671:Amputation, Surgical; D003646:Debridement; D005240:Feasibility Studies; D005269:Femur; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007512:Ischium; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010264:Paraplegia / Q000150:complications; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000637:transplantation*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016038:Skin Transplantation; D013119:Spinal Cord Injuries / Q000150:complications; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery; D014945:Wound Healing