Evaluation of surgical treatment of pressure sore patients: 30 years of experience

Abstract

Pressure sores develop as a result of continuous or intermittent pressure applied to a localized area, leading to tissue damage. Elderly, frail and long-term bedridden patients constitute a significant risk group. Pressure sores are treated both conservatively and surgically. Between 1993 and 2023, 207 patients and 340 pressure sores were examined in our clinic. The etiology of pressure ulcers, age of the patients, gender distribution, localization of the wounds, flap options, postoperative complications and recurrence rates were evaluated. Of the 207 patients evaluated, 127 (61.3%) were male and 80 (38.6%) were female, with a mean age of 44 years. Of the 340 wounds, 129 (37.4%) were in the sacral region, 92 (27.4%) in the ischial region, 69 (20.2%) in the trochanteric region, and 50 (15%) in other regions. In terms of clinical status, 64% were plegic, while 36% were bedridden (non-plegic). Our primary treatment options included the gluteus maximus fasciocutaneous flap for sacral pressure wounds, the inferior gluteus maximus island flap for ischial pressure wounds, and the tensor fascia lata flap for trochanteric pressure wounds. However, the recent introduction of perforator flaps has expanded the range of surgical options available in our clinical approach to pressure sores. Recently, perforator flap techniques—such as propeller flaps and SGAP flaps—have been introduced into our practice for pressure ulcer reconstruction. The most common complication in early postoperative follow-up was suture line separation (7.0%). There was no difference in complication rates between fasciocutane, musculocutaneous or perforator flaps applied in the surgery of pressure ulcers.

Keywords

• Pressure ulcers
• surgical treatment
• musculocutaneous flap
• fasciocutaneous flap
• perforator flap

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