title: [Surgical issues and outcomes in ischial pressure sores treatment].
abstract: BACKGROUND
  Ischiatic pressure sores are frequent in spinal cord injury patients, associated with bad prognosis and high recurrence rate. Many surgical techniques were described, including surgical debridement followed by pedicled flap coverage. We aim to propose a practical decision tree for primary or secondary ischial pressure sore treatment.
  
  
  METHODS
  Our series of 48 operated ischial sores with an average follow up of 4 years (range 2 to 8years) is analyzed and compared to previously published reports. Surgical techniques are discussed according to their specific indications.
  
  
  RESULTS
  The optimal recurrence rate in published reports about pressure sore treatment is 20%; a rate inferior to 19% is found in our series, showing the equal importance of flap selection and postoperative care and education. Depending on each situation, various available flaps are described and compared: gluteus maximus flap, biceps femoris flap, gracilis flap, tensor fascia lata flap, fasciocutaneous thigh flaps, rectus femoris and vastus lateralis flap, rectus abdominis flap. Specific surgical indications for more extensive wounds are studied: resection arthroplasty of the hip, hip disarticulation, fillet flaps from the leg, microsurgery.
  
  
  CONCLUSIONS
  Based upon our experience, a decision tree summarizes our proposition of flap selection, depending on the wound size and the patient background.
authors.affiliation: Centre des brûlés, service de chirurgie plastique, centre hospitalier Saint-Joseph-Saint-Luc, 20 quai Claude-Bernard, Lyon, France. dvoulliaume@ch-stjoseph-stluc-lyon.fr
authors.forename: D
authors.initials: D
authors.lastname: Voulliaume
authors.forename: M
authors.initials: M
authors.lastname: Grecea
authors.forename: R
authors.initials: R
authors.lastname: Viard
authors.forename: A
authors.initials: A
authors.lastname: Brun
authors.forename: J-P
authors.initials: JP
authors.lastname: Comparin
authors.forename: J-L
authors.initials: JL
authors.lastname: Foyatier
mesh_terms: D000328:Adult; D000368:Aged; D003663:Decision Trees; D005260:Female; D006615:Hip; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult