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Ischial pressure sore

Mustafa Durgun, Soysal Bas
BACKGROUND: Reconstructive choices for the defects of the sacral and ischial regions include various steps of the reconstructive ladder from primary closure to free flaps. This study aimed to present repair of sacral and ischial region defects with lateral sacral artery perforator (LSAP) flaps. METHODS: We enrolled a total of 18 patients with sacral and ischial region defects reconstructed with LSAP flaps in the study between September 2014 and October 2015. The patients were evaluated in terms of age, sex, neurological situation, etiology, defect size, defect region, flap size, perforator number, and postoperative complications...
March 2019: Annals of Plastic Surgery
Shabana Z Shafy, Mohammed Hakim, Mauricio Arce Villalobos, Gregory D Pearson, Giorgio Veneziano, Joseph D Tobias
Duchenne muscular dystrophy (DMD), first described in 1834, is an X-linked dystrophinopathy, leading to early onset skeletal muscle weakness. Life expectancy is reduced to early adulthood as a result of involvement of voluntary skeletal muscles with respiratory failure, orthopedic deformities, and associated cardiomyopathy. Given its multisystem involvement, surgical intervention may be required to address the sequelae of the disease process. We present a 36-year-old adult with DMD, who required anesthetic care during surgical debridement of an ischial pressure sore...
2018: Local and Regional Anesthesia
Dariusz Bazaliński, Paweł Więch, Dorota Kaczmarska, Izabela Sałacińska, Maria Kózka
RATIONALE: Effective wound healing depends on the adequate choice of the wound cleansing method, to enable rapid removal of necrotic tissue. Negative pressure wound therapy (NPWT) is an effective non-invasive technique for management of wounds of varied aetiology, including deep tissue injuries caused by pressure. PATIENT CONCERNS: This article discusses a case of an 82-year-old female receiving hospice care at home owing to progressing untreated thoracic spinal stenosis, bedridden for 4 years, incapable of self-care...
July 2018: Medicine (Baltimore)
Umesh Kumar, Pradeep Jain
Objective: The objective of the study was to determine the feasibility of infragluteal fasciocutaneous flap in recurrent ischial pressure sore. Materials and Methods: In our study, from 2015 to 2017, nine patients suffering from recurrent ischial sore with scars of previous surgery were managed with infragluteal fasciocutaneous flap. Wound bed was prepared by surgical debridement and negative pressure wound therapy in each case. In two cases, gracilis muscle flap was used as adjuvant to fill up the residual cavity...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Ashley L de Padua, Kimberly Strickland, Mary Patrick, John F Ditunno
Introduction: Women with spinal cord injury (SCI) and who develop breast cancer are a vulnerable and potentially overlooked population. They experience risk factors owing to decreased mobility and are at risk for unique complications from their oncologic treatment. Case presentation: A 54-year-old woman who suffered a T6 AIS A traumatic SCI in 1981, who was diagnosed 32 years later with estrogen receptor and progesterone receptor positive and human epidermal growth factor receptor 2-negative invasive ductal carcinoma...
2018: Spinal Cord Series and Cases
M Vantomme, R Viard, R Aimard, P-L Vincent, J-P Comparin, D Voulliaume
INTRODUCTION: The ischiatric pressure sore is a common pathology in rehabilitated spinal cord injured people, despite careful prevention. Medical treatment by discharge and directed healing is not always sufficient and surgery using local musculocutaneous flaps is often essential. Unfortunately, recidivism is frequent and the availability of local flaps is limited. The scrotal flap is an excellent complement to classic flaps, gluteal flaps or hamstrings. It can be used alone or in addition to another musculocutaneous flap, in first or second intention...
April 11, 2018: Annales de Chirurgie Plastique et Esthétique
Catherine M Legemate, Monique van der Kwaak, David Gobets, Menno Huikeshoven, Paul P M van Zuijlen
BACKGROUND: The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. METHODS: A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017...
June 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
L Gebert, F Boucher, A Lari, F Braye, A Mojallal, M Ismaïl
INTRODUCTION: The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers...
April 2018: Annales de Chirurgie Plastique et Esthétique
Gabriel Djedovic, Evi M Morandi, Julia Metzler, Anna Wirthmann, Johannes Matiasek, Thomas Bauer, Ulrich M Rieger
The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight-bearing area in wheelchair-mobilised patients and is prone to high mobility. The purpose of our study was to report our long-time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap. A retrospective analysis of all primary pressure sores grade III-IV in the ischial area, which were covered with a medially based posterior thigh flap between January 2008 and December 2014, at our department was conducted...
December 2017: International Wound Journal
M Akguner, C Karaca, A Atabey, A Menderes, H Top
Surgical reconstruction of ischial pressure sores is technically complex and presents a significant problem. Although there is consensus about the use of muscle or myocutaneous flaps in the closure of these sores, there is still dispute about which muscle or myocutaneous flap to use. This evaluation describes the use of the gracilis myocutaneous flap for the treatment of wide and chronic ischial pressure sores. Details of 14 cases are presented and compared with those described in the literature.
June 2, 1998: Journal of Wound Care
A Khanna, H P Henderson, M S A Beg
A method for the reconstruction of ischial defects is outlined, citing some particular advantages of the technique.
March 2, 1994: Journal of Wound Care
Corné P G Nel, Mahendra Daya
BACKGROUND: Large defects arising from extirpation surgery of buttock sarcomas requiring adjuvant radiotherapy are best closed with flap surgery. The traditional solutions are derived from an approach to pressure sores, which were designed for the ischial, sacral, or trochanteric areas, and have now been adapted for true buttock defects. This invariably destroys the esthetics of the buttock. We describe a novel technique of sigmoidplasty, which preserves most of the esthetic features...
October 2016: Plastic and Reconstructive Surgery. Global Open
P-L Vincent, B Pinatel, R Viard, J-P Comparin, P Gir, D Voulliaume
AIM OF THE STUDY: The coverage of ischiatic pressure ulcers is characterized by a significant recurrence rate (8-64% depending on the series). It therefore seems necessary to introduce the concept of saving in the use of muscle flaps available to avoid being in a situation of therapeutic impasse. The gluteus maximus inferior split-muscle flap allows a tailored coverage to the ischiatic pressure ulcers grade IV with skin defect less than 8cm after surgical debridement. It is associated with an advancement-rotation skin flap removed above the sub-gluteal fold...
December 2016: Annales de Chirurgie Plastique et Esthétique
C H Thomson, M Choudry, C White, M Mecci, H Siddiqui
INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide descriptive data as well as share the experience of treating these complex wounds. MATERIALS AND METHODS Patients operated on as a joint case from 2010 to 2014 were identified through a locally held database and hospital records were then retrospectively reviewed for perioperative variables...
February 2017: Annals of the Royal College of Surgeons of England
S Tadiparthi, A Hartley, L Alzweri, M Mecci, H Siddiqui
BACKGROUND AND AIM: Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced...
July 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
S Pesenti, C Ciceron, E Toledano, J Niddam, H Tournebise
BACKGROUND: Pressure sores are a frequent complication in spinal injured people. Their treatment is often long and complex. OBSERVATION: We report the case of a 60-year-old man affected with complete paraplegia who developed a right trochanteric pressure ulcer complicated with osteoarthritis of the coxofemoral joint. The treatment was done in three steps. First, a large excision of necrotic tissues and a femoral head-neck resection is performed. Then, the defect is partly covered with a Gluteus Maximus and a Biceps Femoris myocutaneous flaps...
December 2016: Annales de Chirurgie Plastique et Esthétique
Stefano Bonomi, André Salval, Federica Brenta, Vincenzo Rapisarda, Fernanda Settembrini
BACKGROUND: Many procedures have been proposed for the treatment of pressure sores, and V-Y advancement flaps are widely used to repair a defect. Unfortunately, the degree of mobility of a V-Y advancement flap is dependent on the laxity of the underlying subcutaneous tissue. This is an important disadvantage of traditional V-Y advancement flap and limits its use.We used V-Y advancement flaps as perforator-based to overcome mobility restriction problem, with a further modification (Pacman-like shape) to improve the covering surface area of the flap...
September 2016: Annals of Plastic Surgery
M Marchi, S Battaglia, S Marchese, E Intagliata, C Spataro, R Vecchio
BACKGROUND: Pressure ulcers are frequent complications for long term hospitalized bed-ridden patients which are not able to move or move very little. In fact, the lesion forms in a skin and muscle region which undergoes a constant pressure between an underlying bone protrusion and a support structure such as a bed or a wheelchair. Initially only the outer layers are involved but in time, the ulcer can spread to the deeper structures and reach the bone. PATIENTS AND METHODS: In our work we described the anatomical areas that are most often subject to developing a pressure ulcer and we considered the surgical treatment and reconstructive procedures which are applied using a logical and rigorous sequence...
May 2015: Il Giornale di Chirurgia
Ingo Kuhfuss, Alessandro Cordi, Philip Zeplin
INTRODUCTION: 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...
February 20, 2015: Journal of Medical Case Reports
Yi Liu, Xianying Zhang, Bin Xiao, Mei Song, Ping Liu, Jiang Jiang, Cheng Zhang, Xusheng Zhang, Liming Chen
OBJECTIVE: To sum up the clinical characteristics, surgical management, and effectiveness of pressure sore of sinus type. METHODS: Between January 2009 and April 2013, 17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated, and the clinical data were analyzed retrospectively. There were 11 males and 6 females with an average age of 27.4 years (range, 17-49 years). The median disease duration was 1.5 years (range, 6 months to 7 years)...
August 2014: Chinese Journal of Reparative and Reconstructive Surgery
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