Gluteal perforator flaps for coverage of pressure sores at various locations.
Gluteal perforator flaps for coverage of pressure sores at various locations.
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DOI：
10.1097/01.prs.0000219990.35120.13
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发表时间：
2006
影响因子：
3.6
通讯作者：
Jui-Tien Lee;H. Hsiao;K. Tung;Shan-Yuan Ou
中科院分区：
文献类型：
--
作者：
Jui-Tien Lee;H. Hsiao;K. Tung;Shan-Yuan Ou
Management of pressure sores is one of the most formidable challenges confronting the reconstructive plastic surgeon. Traditionally, muscle and musculocutaneous flaps were used for the treatment of pressure sores. However, this clinical approach of using the “pressure dispersing” effects of muscle appears to conflict with certain experimental observations. In the 1960s, Kosiak1 and Keane2 demonstrated that muscle is more susceptible to the effects of pressure than either skin or subcutaneous tissue. Keane2 demonstrated that body weight is borne on superficial bony prominences covered only by skin and subcutaneous tissue, thus protecting muscle from the effects of ischemia. In normal weight-bearing positions over bony prominences, muscle is rarely interposed between bone and skin. When muscle and musculocutaneous flaps are used, the use of adjacent flaps is often obviated because of violation of vascular territories. Furthermore, muscle, and its function are sacrificed, which is especially important in ambulatory patients. In the late 1980s, Kroll and Rosenfield3 introduced the concept of perforator flaps. Perforator flaps, supplied by musculocutaneous perforators, obviate the need for muscle or musculocutaneous flaps, thus minimizing donor-site morbidity. These flaps have gained popularity during the past decade with their current application to pressure sore management by the authors. The rationale for the use of fasciocutaneous perforator flaps can be found in some of the earlier literature on flap physiology.1,2 Fasciocutaneous perforator flaps are durable, safe, and reliable; can be elevated in various locations; permit freedom in flap design; and are associated with low donor-site morbidity. The donor site can often be closed directly. Coşkunfırat and Özgentaş are to be congratulated for their impressive experience with 35 gluteal perforator flaps for coverage of 22 sacral, seven ischial, and six trochanteric pressure sores in 32 patients including 18 who were plegic and five who were bedridden. The authors report an excellent survival rate, with only one flap loss, two wound dehiscences treated by secondary closure, and only one recurrence during the 13.6-month follow-up period. These results are quite remarkable because the factors contributing to recurrence following surgery are often beyond the surgeon’s control. Soft-tissue integrity ultimately depends on the patient’s ability to restore blood flow following ischemia and the avoidance of prolonged pressure. Malnutrition, anemia, concomitant medical problems, shear forces, spasm, infection, and patient compliance are the major variables in the equation. Perhaps the most frustrating aspect of pressure sore management is the high incidence of recurrence, which tremendously increases medical costs and patient morbidity. The authors’ results are outstanding, especially when one considers their exceptionally low incidence of recurrence. Although the follow-up period is short, the recurrence rate is nevertheless the lowest of which I am aware for a similar series. In 1956, Conway and Griffith4 reported on 1000 ischial pressure sore patients, consisting predominantly of plegic and bed-dependent patients. Regardless of the type of treatment (surgical or nonsurgical), recurrence rates were 75 to 77 percent. In 1992, Disa et al.5 reported a 61 percent recurrence rate after
