title: Recurrent ischial pressure ulcer resolved with a novel tissue adhesive: a case report.
abstract: BACKGROUND
  Patients with stage III and IV pressure ulcers requiring surgical reconstruction remain a challenge. Extended hospitalization, and high costs of care per patient episode due to high rates of complications and recurrence, make efforts to reduce these rates of utmost importance to the medical community in general. We report a case in which two prior attempts at surgical resolution had failed, and which was successfully resolved with the aid of a new tissue adhesive designed for the closure of dead space. To the best of our knowledge, this is the first reported example of the use of this adhesive in flap surgery for pressure ulcers.
  
  
  METHODS
  We report the case of a 42-year-old Caucasian wheelchair-bound paraplegic man with history of spina bifida, urinary catheter, colostomy, and a history of pressure ulcers. He presented to our institution with a stage IV, methicillin-resistant Staphylococcus aureus-contaminated pressure sore on his left ischial tuberosity. A first procedure using V-Y and rotational flap closure dehisced on postoperative day three due to his excessive movement. A second procedure was performed but this also required revision due to dehiscence related to fluid accumulation under the flap. A third procedure using TissuGlu(®) Surgical Adhesive to adhere the flap and close the dead space resulted in successful resolution. At his last follow-up appointment at seven weeks post-operation he was healing well and was back in his wheelchair.
  
  
  CONCLUSIONS
  Any reductions in hospital stay, complication rates, or recurrence rates would be important in this highly problematic group of patients. Elimination of the dead space where fluids can accumulate, combined with adhesion of the flaps with a sufficient strength to withstand the shear forces commonly encountered, could represent an important advancement in the treatment of pressure ulcers requiring surgical repair with myocutaneous or fasciocutaneous flaps. Our initial experience in this case suggests that TissuGlu(®) may be able to help reduce recurrence rates in this challenging group of patients.
authors.affiliation: Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie St Josefs-Hospital, Dreieckstr. 17, 58097, Hagen, Germany. i.kuhfuss@kkh-hagen.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Kuhfuss
authors.affiliation: Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie St Josefs-Hospital, Dreieckstr. 17, 58097, Hagen, Germany. alessandrocordi@gmx.de.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cordi
authors.affiliation: Universitätsklinikum Leipzig; Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Liebigstr. 20, 04103, Leipzig, Germany. Philip.zeplin@medizin.uni-leipzig.de.
authors.forename: Philip
authors.initials: P
authors.lastname: Zeplin
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D010264:Paraplegia / Q000150:complications; D003668:Pressure Ulcer / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps / Q000098:blood supply; D014014:Tissue Adhesives; D014945:Wound Healing
chemical_list: D014014:Tissue Adhesives