Comparison of Fasciocutaneous Flaps and Gracilis Muscle Flaps in Ischial Pressure Ulcer Reconstruction

Year 2022, , 1 - 7, 30.04.2022

İbrahim Tabakan , Damla Gencel , Ömer Kokaçya , Cengiz Eser , Eyüp Gencel

https://doi.org/10.36516/jocass.2022.92

Abstract

Aim: The reconstruction options for pressure ulcers have been widely reported, but there is still a need for ideal method in ischial pressure ulcer reconstruction. The aim of this study is to compare the development of recurrence and wound site complications and length of stay in two different patient groups who were treated for ischial pressure ulcers with a combination of gracilis muscle flap and fasciocutaneous flap procedures and those who were treated only with local fasciocutaneous flaps.
Methods: Between 2016 and 2022, a total of 34 patients with Grade 3 and 4 ischial pressure ulcers were analyzed retrospectively in the Plastic, Reconstructive, and Aesthetic Surgery Clinic of Çukurova University’s Faculty of Medicine. Of this total patient group, 18 were treated with a combination of gracilis muscle flap and fasciocutaneous flap procedures (Group 1) and 16 were treated with local fasciocutaneous flaps (Group 2).
Results: The mean age of the patients was 39 in Group 1 and 44.5 in Group 2. Group 1 patients had a mean length of stay of 9 days, while those in Group 2 had a mean length of stay of 15 days. Early postoperative complications such as dehiscence and hematoma occurred in both patient groups. While complications occurred in 6 patients in Group 1 (33.3%), 7 patients experienced complications in Group 2 (43.8%).
Conclusions: Reconstruction of ischial pressure ulcers is very problematic due to high recurrence rates. Therefore, a wide range of repair options have been defined. Fasciocutaneous flaps may be insufficient to obliterate the dead space alone. In addition to a skin flap, gracilis muscle flap can be an effective option for the ischial cavity with better surgical outcomes.

Keywords

Ischial pressure ulcer, gracilis muscle flap, reconstruction

İskial Bası Ülserlerinin Onarımında Gracilis Kas Flebinin Fasyokutan Fleplerle Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı iskial bası ülseri nedeniyle gracilis kas flebi ve lokal fasyokutan fleplerle onarım yapılan iki ayrı hasta grubunun yara yeri komplikasyon gelişimi ve yatış süresi açısından karşılaştırılmasıdır.
Materyal ve Metod: Çukurova Üniversitesi Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi Kliniğinde, 2016-2021 yılları arasında grade 4 iskial bası ülseri nedeniyle gracillis muskulokutan flebi ile onarım yapılan 18 hasta (Grup1), lokal fasyokutan fleplerle onarım yapılan 16 hasta (Grup2) olmak üzere toplam 34 hasta retrospektif olarak incelenmiştir.
Bulgular: Hastaların yaş ortalaması Grup1’de 39, Grup 2’de 44,5’ti. Ortalama yatış süresi Grup1’de 9 gün iken, Grup 2’de 15 gündü. Hastalarda sütur ayrışması ve hematom gibi erken postoperatif komplikasyonlar gelişti. Grup1’de 6 hastada komplikasyon gelişirken (%33,3), Grup2’de 7 hastada komplikasyon gelişti (%43,8).
Sonuç: İskial bası ülserlerinin onarımı yüksek nüks oranları nedeniyle oldukça sorunludur. Bu nedenle onarımda çok sayıda seçenek tanımlanmıştır. Tek başına fasyokutan fleplerle yapılan onarımlar iskial bölgedeki bası ülseri poşunu doldurmada yetersiz kalabilir. Gracillis kasını iskial poşa yerleştirip üzerine fasyokutan fleplerle kombine etmek erken postoperatif komplikasyonları ve nüks gelişimini azaltmak için dikkate alınması gereken bir seçenektir.

Keywords

ischial pressure ulcer, gracillis flap, reconstruction

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