title: Expanded Flaps in Surgical Treatment of Pressure Sores: Our Experience for 25 Years.
abstract: BACKGROUND
  Because the ischial region is the main weight-bearing area in sitting, it is one of the areas most frequently affected by pressure ulcers in paraplegic patients resuming the sitting position during the subacute and chronic stages. The techniques described to date have not been able to reduce the high rates of recurrence and flap dehiscence. Other groups have described successful tissue expansion in the treatment of pressure ulcers, but to date, the long-term results of the procedure have not been reported.
  
  
  METHODS
  The long-term follow-up of 138 reconstructions of the ischial region in patients with pressure ulcers types III to IV treated with posterior thigh expanded rotation flaps is reported.
  
  
  RESULTS
  All patients achieved complete resolution, with adequate coverage of deeper layers, although 15.94% presented minor complications. None of these complications impeded full repair of the lesion. The 28 lesions that recurred were all reconstructed with the re-expansion of the same flap. There were no cases of flap dehiscence.
  
  
  CONCLUSIONS
  The use of tissue expanders to treat ischial pressure ulcers, especially in patients with long life expectancy, offers important advantages over other approaches. The procedure provides abundant, high-quality tissue and may be repeated many times without creating new scars. With the use of tissue expanders, other reconstructive options can be reserved for the future.
authors.affiliation: From the *Department of Morphofunctional Rehabilitation in Plastic Surgery, Salvatore Maugeri Foundation (IRCCS), Telese, Italy; and †Plastic and Reconstructive Surgery Department, Second University of Naples, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Caprio
authors.forename: José Maria
authors.initials: JM
authors.lastname: Serra-Mestre
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ziccardi
authors.forename: Michelina
authors.initials: M
authors.lastname: Scioli
authors.forename: Fabio
authors.initials: F
authors.lastname: Larocca
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Nunziata
authors.forename: Roberto
authors.initials: R
authors.lastname: Grella
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Andrea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007512:Ischium; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult