Wednesday, August 10, 2022
HomeWoundsindex/list_12277_1Effect of Flap Selection on the Postoperative Success of Sacral Pressure Injuries

Effect of Flap Selection on the Postoperative Success of Sacral Pressure Injuries

Abstract and Introduction


Introduction: Pressure injuries (PIs) continue to be a substantial problem and burden for the present-day health care system and are the leading cause of chronic wounds worldwide. There is no current consensus on the long-term results of the use of flaps in sacral PI reconstruction and optimal flap choice.

Objective: This study aimed to evaluate whether flap selection influences postoperative results in sacral PI reconstruction.

Materials and Methods: Patients who underwent surgery for PIs in the authors’ clinic between 2002 and 2016 were retrospectively analyzed. A total of 63 patients with stage 3/stage 4 sacral PIs and who underwent reconstruction with fasciocutaneous (FC) flaps (group 1), musculocutaneous (MC) flaps (group 2), or perforator (P) flaps (group 3) were included in the study. The mean duration of the follow-up period was 14.4 months, and patients were evaluated in terms of their demographic data, length of hospital stay, complications, and recurrence.

Results: The mean age, sex distribution, and ambulatory status were similar between the groups. In group 2 (MC), the mean length of hospital stay and mean drain removal time were significantly longer. The mean daily drainage amount was significantly higher in group 2 (MC) than in the other groups, and long-term relapses were less frequently observed in group 3 (P). A significant difference was observed between groups 2 (FC) and 3 (MC) in terms of wound dehiscence. The authors determined that P flaps were associated with a reduced mean length of hospital stay and daily drainage.

Conclusions: For these patients, P flaps appear to be the optimal flap choice for sacral area reconstruction. However, new prospective randomized studies are needed to support these findings.


Pressure injuries (PIs) are defined as tissue injuries caused by unrelieved pressure over a bony prominence.[1,2] Treatment of patients with this wound type can be challenging for medical professionals, nursing staff, and health care providers worldwide. Treatment success is limited to the closure of defects and prevention of long-term relapse. This wound type is commonly seen in the sacral area; anatomic location, presence of additional comorbidities, bed confinement status, malnutrition, immobility, lack of sensation, and inadequacy of social care services are factors that can negatively affect reconstruction success. In the literature, various flap options have been identified to reconstruct sacral PIs, but studies that compare these options using postoperative results are limited.[3–8]

In this study, the authors conducted a retrospective evaluation of postoperative complications, clinical outcomes, and PI recurrence during 14 months of follow-up for patients who had received musculocutaneous (MC), fasciocutaneous (FC), or perforator (P) flaps for a sacral PI.

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