86 - Flap coverage for pressure sores

Summary

“Pressure sore” is the term used to describe ischemic tissue loss resulting from pressure, usually over a bony prominence. With an incidence of 1.5 to 3.0 million new cases in the USA annually, the condition is a common problem. Pressure sores typically arise in paralyzed or otherwise debilitated patients, usually occurring in the lower part of the body; the sacrum, heel, trochanters, and ischium are the most frequent sites. Since the etiology of these lesions is always unrelieved pressure, prevention remains the cornerstone of any management plan and includes minimizing stress over these prominences and meticulous skin care. The majority of pressure sores will heal, with non-operative wound management consisting of infection control, dead tissue debridement, pressure avoidance, and dressing changes. However, those instances involving significant tissue loss in which the sores will not readily close on their own do require surgical closure. Reconstruction should be performed only in patients who can avoid placing pressure on the affected areas in the future; otherwise, the problem will quickly recur. Thus, only a select few patients with pressure sores are appropriate candidates for operative reconstruction.

Prior to repair, pressure sores must be clean and free of infection. This may require hospital admission well in advance of operation for aggressive wound care. Other issues which must be addressed preoperatively include: optimization of nutrition status, with tube feeding or hyperalimentation if necessary; correction of anemia; alleviation of contributing spasm; and release of contractures. Once these issues are resolved, operation can be safely performed.