[Decubital ulcer--causes, surgical therapy and prognosis].
7.6 % (n = 134/1 769) of all inpatients in Leuven, but 30.1 % of risk patients suffer of pressure sores (Norton Scale 10.4 points). Predisposed are geriatric patients or those of intensive care units. While fasciocutaneous flap likewise the superior gluteal artery perforator flap are more resistant to mechanical forces, myocutaneous flaps are the working horse for pressure sores with deep-tissue pockets or osteitis (Campbell stage > IV). Partial resection of the median sacral crest or ischiectomy are obligatory. In analyzing a 16 years period only 33 percent of myocutaneous flaps healed uneventful, while due to multiple enumerations more than 50 percent presented complications. Partial flap and complete necrosis happened in 6 respectively in 2 percent. Rectus abdominis myocutaneous flap reconstruction as well as the free tissue transfer are useful alternatives to hip disarticulation with total thigh flap coverage or a complete fillet flap of the lower extremity. Independently of the selected closure 50 percent of all decubitus patients will develop recurrences in longterm follow up. Thus prevention is of utmost importance. In Europe the costs for the hospitalisation of a patient with concomitant decubital ulcers are 2.5-times higher than for an average, non-afflicted patient.
Brenner
P
P
Department für Plastische, Rekonstruktive und Asthetische Chirurgie, Handchirurgie- und Brandverletztenzentrum der Katholischen Universität Leuven, Belgien. ProfPBrenner@aol.com
Krause-Bergmann
A
A
D006801:Humans; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D003668:Pressure Ulcer / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D013524:Surgical Flaps