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Perforator Flaps in Late-Stage Pressure Sore Treatment: Outcome Analysis of 11–Year-Long Experience With 143 Patients

Grassetti, Luca MD*; Scalise, Alessandro MD*; Lazzeri, Davide MD; Carle, Flavia PhD; Agostini, Tommaso MD§; Gesuita, Rosaria PhD; Di Benedetto, Giovanni MD, PhD*

doi: 10.1097/SAP.0b013e31828587a8
Reconstructive Surgery

Background In the last decade, perforator flaps have been introduced for the treatment of pressure ulcers as alternative to the more popular myocutaneous local flaps. We reviewed our single-team 11-year experience in order to define whether real advantages could be achieved.

Methods We analyzed 143 patients undergoing perforator flap surgery for a single late-stage pressure sore. All patients underwent the same protocol treatment. Data regarding associated pathologies, demographics, complications, healing, and hospitalization times were collected.

Results Ninety-three percent of 143 patients were white Caucasian, and 61% were men, with median age of 51 years. Of 143 stage 4 ulcers, 46.2% were ischial, 42.7% sacral, and 11.2% trochanteric. The most common diagnosis was traumatic paraplegia/tetraplegia (74.9%); no significant difference was found in diagnosis distribution and in ulcer location between recurrent and nonrecurrent patients. We performed 44 S-GAP, 78 I-GAP, 3 PFAP-am, and 18 PFAP-1 flaps. At 2 years’ follow-up, the overall recurrence was 22.4% and new ulcer occurrence was 4.2%. Mean hospital stay was 16 days. The overall complication percentage was 22.4%, mostly due to suture-line dehiscence (14%) and distal flap necrosis (6.3%). PFAP flaps had a significant higher risk of developing recurrence than I-GAP flaps. The recurrence risk was significantly higher for subjects suffering from coronary artery disease.

Conclusions Late-stage pressure sore treatment with local perforator flaps can achieve reliable long-term outcomes in terms of recurrences and complications. When compared to previously published data, perforator flaps surgery decreased postoperative hospital stay (by an average of nearly 1 week), reoperations (5.6%), and occurrences.

From the *Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona; †Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Pisa; ‡Department of Epidemiology and Biostatistics, Marche Polytechnic University Medical School, Regional Hospital, Ancona; and §Maxillofacial Surgery Unit, University Hospital of Florence, Florence, Italy.

Received September 8, 2012, and accepted for publication, after revision, December 31, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Luca Grassetti, MD, Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Via Conca 1—60020 Ancona, Italy. E-mail:

© 2014 by Lippincott Williams & Wilkins