Surgical Repair Involving Tissue Flap Transplantation with Vascular Pedicle in Treating Refractory Pressure Ulcers Around Hip and Sacral Region

Objective: To explore the therapeutic methods on surgical repair of refractory pressure ulcers around hip and sacral region, and to conclude the focuses of the surgical treatment. Materials and Methods: From January 2007 to December 2013, tissue flap transport with vascular pedicle was applied to repair 77 cases refractory pressure ulcers (96 wounds) around hip sacral region, with the patients aging from 21 to 82. For the positions of the 96 wounds, 34 wounds were on the sacrococcygeal region, 21 in femoral major trochanteric portion, and 41 on the ischial tuberosity. The size of smallest pressure ulcer was 1cm×2cm, and the biggest was 12×16cm, all were accompanied by infections with different degrees. Among all the cases, 38 wounds were repaired by gluteus maximus myocutaneous flaps, 11 wounds were repaired by gracilis myocutaneous flaps, and 12 wounds were repaired by long end of musculus biceps femoris myocutaneous flaps; 34 wounds repaired by fasciocutaneous flaps, including 10 wounds by posterior fasciocutaneous flaps; and 5 cases were healed by hip disarticulation and repaired by bone musculocutaneous flaps. Results: 75 of the 77 patients were healed after the operation, while 2 failed to be healed because of their old age and poor nutritional status. According to the follow-ups, 4 of the healed patients with pressure ulcers on ischial tuberosities relapsed 1 year after the operation, and were thoroughly healed by second operation of biceps femoris myocutaneous flaps transport; the transplanted myocutaneous flaps of other cases all survived and no recurrence of pressure ulcers happened, that the surgical treatment received satisfactory results. Conclusion: Combining the supportive therapeutics of nutritional support and control of the infections, surgical treatment of tissue flap transport with vascular pedicle could reach satisfactory results for repair refractory pressure ulcers around hip and sacral region.