title: Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years.
abstract: BACKGROUND
  Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates.
  
  
  METHODS
  A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training.
  
  
  RESULTS
  Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55-23.3) and deep dehiscence (OR 12.3, 95% CI 1.99-76.9).
  
  
  CONCLUSIONS
  The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Sumanas W
authors.initials: SW
authors.lastname: Jordan
authors.affiliation: Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: De la Garza
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: nw_aesthetics@yahoo.com.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Lewis
mesh_terms: D000328:Adult; D001706:Biopsy; D002061:Bursa, Synovial / Q000601:surgery; D002081:Buttocks; D003646:Debridement; D004210:Dissection / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D000070633:Hamstring Muscles / Q000601:surgery; D006801:Humans; D007512:Ischium / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy; D003668:Pressure Ulcer / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome
keywords: Ischial pressure ulcer; Muscle flap; Osteomyelitis; Spinal cord injury