title: Cutaneous flaps in the treatment of 338 pressure sores: a better choice.
abstract: OBJECTIVE
  Muscular flaps are considered by many surgeons as a treatment of choice for pressure sores. Nevertheless fasciocutaneous and adipofascial flaps are less sensitive to ischemia, more resistant to pressure and have higher mechanical resistance. The aim of this study is to evaluate the results of our integrated rehabilitative and surgical protocol in pressure sore management based on the use of cutaneous flaps.
  
  
  METHODS
  Since 1998, we treated 338 pressure sores (PS) in 195 patients (120 males; 75 females), 189 patients were affected by paraplegia and tetraplegia and 6 of them by neurological disorders.
  
  
  RESULTS
  Ninety sacral, 156 ischiatic, 75 trochanteric, 9 calcanean and 8 sores of the iliac-crest were succesfully treated. All showed an involvement of the bone element, with osteitis and/or periosteitis. 14 cases of trocanteric sores showed a deeper bone involvement, with evidences of osteomyelitis. Follow up ranges from 7 years to 2 months. Median time for wound healing was 18 days.
  
  
  CONCLUSIONS
  The use of fasciocutaneous flaps, as an alternative to the traditional muscolocutaneous flaps in the treatment of pressure sores leads to good and statistically comparable, healing rate, time and incidence of complications. Reconstructive plastic surgery as is a decisive factor to reach a good rehabilitative outcome, minimizing the time of rehabilitation with a following decrease of hospitalization costs. In spinal cord injured patients, surgical treatment of pressure sores is not proposed as the main procedure, but it is an important stage during the natural history of pressure sores.
  
  
  CONCLUSIONS
  Cutaneous, adipofascial and fasciocutaneous flaps are less invasive, of a relatively easy execution, provided by a reliable vascular pedicle and they could be "re-used" in case of recurrences.
authors.forename: Manfredi
authors.initials: M
authors.lastname: Greco
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Tempesta
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggiero
authors.forename: Marco
authors.initials: M
authors.lastname: Marcasciano
authors.forename: Bruno
authors.initials: B
authors.lastname: Carlesimo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D055815:Young Adult