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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
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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: lucagrassetti2000@live.it.

© 2014 by Lippincott Williams & Wilkins