Selection of surgical technique in treatment of pressure sores

Introduction: Despite advances in medicine, pressure sores are still a serious problem. The incidence of bedsores in hospitalized patients is 3% to 10%, and 20% in those with neoplasms. A group of patients at high risk of developing pressure ulcers (39%) is those with para- and tetraplegia after spinal cord injuries. The main factors responsible for developing bedsores are pressure, shearing forces and friction. Bedsores usually occur in the sacral, ischial and trochanteric regions. Aim: To present operative methods of treating bedsores in selected patients, based on site of pressure sore and general condition, treated in the Clinic of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz. Material and methods: During 2003-2009, 36 patients (25 males and 11 females) were treated for bedsores in the Clinic of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz. Most patients suffered from paralysis after spinal cord injuries. Trochanteric bedsores were most common (37.5%) and 7 (19%) patients had multiple bedsores. After pre-operative treatment bedsores were excised and loss of tissue was usually covered using flaps from the neighbourhood. Results: The healing was uneventful by 30 (83%) patients. If complications occurred they were due to wound dehiscence caused by infection and poorer healing because of the general condition of the patient (for example DM). In 3 (8%) patients recurrence was observed. Conclusions: We used mainly musculocutaneous flaps, which is thought to be the best method of treating loss of tissue after excision of bedsores.