title: Perforator flaps in late-stage pressure sore treatment: outcome analysis of 11-year-long experience with 143 patients.
abstract: BACKGROUND
  In the last decade, perforator flaps have been introduced for the treatment of pressure ulcers as alternative to the more popular myocutaneous local flaps. We reviewed our single-team 11-year experience in order to define whether real advantages could be achieved.
  
  
  METHODS
  We analyzed 143 patients undergoing perforator flap surgery for a single late-stage pressure sore. All patients underwent the same protocol treatment. Data regarding associated pathologies, demographics, complications, healing, and hospitalization times were collected.
  
  
  RESULTS
  Ninety-three percent of 143 patients were white Caucasian, and 61% were men, with median age of 51 years. Of 143 stage 4 ulcers, 46.2% were ischial, 42.7% sacral, and 11.2% trochanteric. The most common diagnosis was traumatic paraplegia/tetraplegia (74.9%); no significant difference was found in diagnosis distribution and in ulcer location between recurrent and nonrecurrent patients. We performed 44 S-GAP, 78 I-GAP, 3 PFAP-am, and 18 PFAP-1 flaps. At 2 years' follow-up, the overall recurrence was 22.4% and new ulcer occurrence was 4.2%. Mean hospital stay was 16 days. The overall complication percentage was 22.4%, mostly due to suture-line dehiscence (14%) and distal flap necrosis (6.3%). PFAP flaps had a significant higher risk of developing recurrence than I-GAP flaps. The recurrence risk was significantly higher for subjects suffering from coronary artery disease.
  
  
  CONCLUSIONS
  Late-stage pressure sore treatment with local perforator flaps can achieve reliable long-term outcomes in terms of recurrences and complications. When compared to previously published data, perforator flaps surgery decreased postoperative hospital stay (by an average of nearly 1 week), reoperations (5.6%), and occurrences.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona; †Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Pisa; ‡Department of Epidemiology and Biostatistics, Marche Polytechnic University Medical School, Regional Hospital, Ancona; and §Maxillofacial Surgery Unit, University Hospital of Florence, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scalise
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Flavia
authors.initials: F
authors.lastname: Carle
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Benedetto
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome