TWO YEARS WOUND FREE TO FOLLOW UP OF A CHRONIC PRESSURE SORE IN A PARAPLEGIC PATIENT AFTER PERFORMING THREE MUSCLE FLAPS: A CASE REPORT

Authors

  • Hawre A. Hassan Sulaimani Burn, Plastic and Reconstructive Surgery Hospital, Ministry of Health, Kurdistan Region, Iraq.
  • Ari R. Qader Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Vyan H. Mohammed Raouf Sulaimani Burn, Plastic and Reconstructive Surgery Hospital, Ministry of Health, Kurdistan Region, Iraq.
  • Shakhawan S. Zorab Sulaimani Burn, Plastic and Reconstructive Surgery Hospital, Ministry of Health, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10337

Keywords:

Pressure sore, Musculocutaneous flap, Osteomyelitis

Abstract

Background 

Joint involvement underlying pressure sore is a challenge to manage because of the extensive tissue damage that usually requires wide debridement leaving behind significant defects to fill and the possibility of recurrence after reconstruction.

Case Presentation 

We present a case of large communicating ischial and trochanteric pressure sore with femoral head osteomyelitis in a paraplegic patient that was managed by femoral head resection and a musculocutaneous flap instead of lower limb amputation. Management of chronic pressure sores in neglected spinal cord injury patients requires teamwork to prevent a recurrence. We could give our patient a chance and save her lower limb from amputation by a combined vastuslateralis, vastusintermedius and rectus femoris flap (‘three muscle flap’) based on the lateral circumflex femoral artery following proximal femoral resection.

Conclusion

Our two years follow up showed that this method is effective for the management of large deep ischial pressure sores with no recurrence.

References

Evans Gregory. Hip Joint Communication with Pressure Sore The Refractory Wound and the Role of Girdlestone Arthroplasty. Plast Reconstr Surg. 1993;91(2):288–94. DOI: https://doi.org/10.1097/00006534-199302000-00012

Acartürk TO. Treatment of large ischial ulcers communicating with the hip joint with proximal femoral resection and reconstruction with a combined vastus lateralis, vastus intermedius and rectus femoris musculocutaneous flap. J Plast Reconstr Aesthetic Surg. 2009;69(11):1497–502. DOI: https://doi.org/10.1016/j.bjps.2008.04.063

Tadiparthi S, Siddiqui H. Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach. J Plast Reconstr Aesthetic Surg. 2016;69(7):994–1002. DOI: https://doi.org/10.1016/j.bjps.2016.02.016

Guttmann L. The problem of treatment of pressure sores in spinal paraplegics. Br J Plast Surg. 1955;8:196–213. DOI: https://doi.org/10.1016/S0007-1226(55)80037-9

Thiessen FE, Monstrey S. Flap surgery for pressure sores: Should the underlying muscle be transferred or not? J Plast Reconstr Aesthetic Surg. 2011;64(1):84–90. DOI: https://doi.org/10.1016/j.bjps.2010.03.049

G. R. Girdlestone. Acute Pyogenic Arthritis of the Hip: An Operation Giving Free Access and Effective Drainage. Clin Orthop Relat Res. 2008;258–63. DOI: https://doi.org/10.1007/s11999-007-0082-6

Berger SR et al, Surg. rubayi s. AP. Closure of multiple pressure sores with split total thigh flap. Ann Plast Surg. 1994;548–51. DOI: https://doi.org/10.1097/00000637-199411000-00014

Published

2021-12-21

How to Cite

1.
Hassan H, Qader A, Raouf V, Zorab S. TWO YEARS WOUND FREE TO FOLLOW UP OF A CHRONIC PRESSURE SORE IN A PARAPLEGIC PATIENT AFTER PERFORMING THREE MUSCLE FLAPS: A CASE REPORT. JSMC [Internet]. 2021 Dec. 21 [cited 2024 May 27];11(4):503-7. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10337

Similar Articles

1-10 of 36

You may also start an advanced similarity search for this article.