Various types of injuries, especially from automobile accidents continuously add to the number of patients with spinal cord section. pressure sores are a secondary problem for the patient with cord trauma. Because of their occurrence, rehabilitative measures may be postponed, and morbidity is often severe and prolonged; if they are uncontrolled and infection develops, death may ensure.
The provision of adequate soft tissue coverage after one excises pressure sores and bony prominence is a requisite to obtaining stable healing. The usual repairs of these defects involve the use of local flaps. These skin-fat flaps, either medially-based or laterally-based, depend upon a random blood supply; sometimes a delay procedure is required prior to transfer.
The principles of cutaneous axial flaps are now well established, but only a few axial flaps have been described outside of the head and neck area. The reason for this small number is the scarcity of independent, longitudinal, cutaneous vascular territories. It was substantiated that most of the cutaneous blood supply is derived from perforating muscular vessels. Simply stated, most skin flaps are random flaps because the elevation interrupts their usual blood supply.
As alternative method which will provide satisfactory and substantial soft tissue coverage in pressure sores, muscle transpositions of biceps femoris, rectus femoris and gluteus maximus are performed by many authors.
However, if the skin and the underlying muscle was transferred as a compound unit, the natural resistance to shearing forces ad the abundant blood supply are preserved. This report describes the use of two gracilis myocutaneous island flaps and five gluteus maximus myocutaneous flaps as the arterial flap for pressure sores, according with the sites. All cases were successfully treated without significant complication.
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