Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a 'criss-cross' way.

STUDY DESIGN: Description of a technique and prospective follow-up study.

OBJECTIVES: The aim of this study was to present our experience in the surgical treatment of ischial pressure sores, especially recurrence.

SETTING: The Department of Plastic and Reconstructive Surgery and Spinal Injuries Unit, CTO Hospital, Rome, Italy.

METHODS: From 1995 to 1997, the authors used in 12 consecutive paraplegic patients, who had a grade III or IV decubitus ulcer in the ischial area only, two different and independent flaps coupled together in a 'criss-cross' musculocutaneous flap: a split-muscle gluteus maximus flap and a rhomboid fasciocutaneous local flap. The average follow-up period was 3 years and 9 months. Details of the operative procedure are presented to prove that this criss-cross closure of the ischial pressure sore beneficial for patients with spinal cord injury.

RESULTS: All flaps survived; recurrence of the decubitus ulcer occurred in one patient (8%). Pressure-sore-free survival after surgery was 20 months in the patient with recurrence and an average of 26 months in patients without recurrence.

CONCLUSION: The results obtained confirm this procedure to be safe and useful. We believe this technique to be a valuable alternative for the reconstruction of primary or recurrent ischial pressure ulcers.