Flap surgery for pressure sores: should the underlying muscle be transferred or not?
BACKGROUND
Musculocutaneous flaps have become the first choice in the surgical repair of pressure sores, but the indication for including muscle in the transferred flaps still remains poorly defined. This study compares outcomes after muscle and non-muscle flap coverage of pressure sores to investigate whether it is still necessary to incorporate muscle tissue as part of the surgical treatment of these ulcers.


METHODS
A retrospective revision of 94 consecutive patients with ischial or sacral pressure sores operated between 1996 and 2002 was performed. Depending on the inclusion of muscle into the flap, the patients were divided in two groups: musculocutaneous flap group and fasciocutaneous flap group. Charts were reviewed for patient characteristics, ulcer features and reconstructive information. Data between groups were compared with emphasis on early (haematoma or seroma, dehiscence, infections, necrosis and secondary procedures) and late (recurrence) postoperative complications.


RESULTS
A total of 37 wounds were covered with muscle and 57 wounds covered without muscle tissue. The groups were comparable in relation to age, gender, ulcer characteristics and timing for surgery. There were no significant differences in early complications between the study groups. The mean follow-up period was 3.10 ± 1.8 years (range: 0.5 to 6.7). There were no statistical differences in ulcer recurrence between the groups. The type of flap used was not associated with postoperative morbidity or recurrence in the univariate and multivariate analyses.


CONCLUSIONS
The findings of this clinical study indicate that the musculocutaneous flaps are as good as fasciocutaneous flaps in the reconstruction of pressure sores, and they question the long-standing dogma that muscle is needed in the repair of these ulcers.
Thiessen
Filip E
FE
Department of Plastic Surgery, Gent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium. filipthiessen@yahoo.com
Andrades
Patricio
P
Blondeel
Philip N
PN
Hamdi
Moustapha
M
Roche
Nathalie
N
Stillaert
Filip
F
Van Landuyt
Koenraad
K
Monstrey
Stan
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D003668:Pressure Ulcer / Q000175:diagnosis / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012445:Sacrococcygeal Region; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult