Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study.
We have collected data on the second follow-up of 27 patients who underwent musculocutaneous flap closure of their ischial pressure sores. Thirty-seven ulcers were operated on between 1988 and 1993 using the V-Y advancement hamstring musculocutaneous island flap. At the initial follow-up (mean = 20 months) in 1993, despite 33% of patients having had recurrent ulcers and 14.8% having undergone re-advancements, only 14% of patients had non-healing ulcers. In 1997, follow-up period ranged from 18 to 90 months, with a mean of 62 months. Four patients were lost to follow-up resulting in 23 patients (n = 23) for the current study. Nine patients were tetraplegic and the remaining 14 were paraplegic. Four of the 23 patients had died at follow-up therefore making the number of living patients 19 (n = 19). The total number of ulcers operated on in the current study was 29 (U = 29). Overall, ulcer and patient recurrence rates were 41.4% and 47.8% respectively. Despite this, 89.5% of patients had intact flaps at the time of follow-up. We recommend the use of the hamstring V-Y musculocutaneous flap as a reliable and safe reconstructive modality in the management of ischial pressure sores and by identifying the group of patients susceptible to ulcer recurrence we have proposed a protocol for their long-term follow-up.
Tavakoli
K
K
Department of Plastic and Reconstructive Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Rutkowski
S
S
Cope
C
C
Hassall
M
M
Barnett
R
R
Richards
M
M
Vandervord
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications*; D003668:Pressure Ulcer / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps