Ischial pressure sores treated with a sensate gracilis myocutaneous flap

Abstract 

There are problems in finding a definitive treatment of ischial pressure sores because recurrence is frequently observed. The aim of surgical procedures is to cover the ischial region with stable and durable tissue, which has a good neurovascular supply. If the patient with ischial pressure sores has sensation above L3 level, the sensate gracilis musculocutaneous flap can be used to treat the defect after resection of the decubitis. This treatment was performed in 12 paraplegic patients in whom sensation was absent below the L3 level. The median age of the patients was 32.5 years, with ten males and two females. Four patients had recurrent pressure sores. The average time of follow-up was 8 months. Sensation was assessed with moving finger tip pressure, warm and cold cylinders, two point discrimination and dermal cortical somatosensory-evoked potential tests. Sensation was present in the transferred flap. Although the gracilis myocutaneous flap can also be used as a nonsensory flap for the reconstruction of ischial pressure sores in paraplegic patients under L3 level, the sensate gracilis myocutaneous flap should be chosen primarily when there is sensation over the gracilis region.