Biceps femoris flap for closure of ischial pressure ulcers

Abstract : Background : The surgical management of stages III and IV pressure ulcers in spinal cord injury patients is ussually based on a large debridment of necrotic tissue before performing a cover of the defect by a flap. The purpose of our study is to analyze our results in terms of morbidity and recurrence of pressure ulcers covered by biceps femoris musculocutaneous flap and compares it with literature data. Methods : A retrospective clinical study of 23 consecutive patients operated for stage IV ischial pressure ulcers by biceps femoris flap was carried out. Other surgical techniques coverage of pressure ulcers as well as all patients with pressure ulcers on another anatomical location were excluded from this study. An analytical statistics in search of a risk factor for recurrence by log rank test was also performed. Results : The mean follow-up was 68.4 months. Primary healing was obtained without complications in 30.8 and 38.4 % had a recurrence of the ulcer. Seroma was statistically correlated to a significant risk of recurrence of pressure ulcers (p = 0.0284, log rank test), as well as to drains removal before the eighth day (p = 0.0114). Conclusions : Surgical management of ischial pressure ulcers remains as a difficult procedure with significant postoperative complications and a high recurrence rate. Level of Evidence: Level IV, therapeutic study.