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Disarticulation And Total Thigh Flap As A One Stage Procedure For The Treatment of Complex End-Stage Pressure Ulcers in Spinal Cord Injury Patients: A 20 Year Retrospective Review.
Lilian C. Azih, MD, Lori Aliksanian, MD, Salah Rubayi, MD.
Division of Plastic and Reconstructive Surgery Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.

PURPOSE: Extensive recurrent stage IV end stage pressure ulcers presents a unique reconstructive challenge to the plastic surgeon in spinal cord injury (SCI) patients. For the extreme complex end-stage cases when all other flap options have been exhausted, a hip disarticulation with total thigh flap may be the only reconstructive option.
METHODS: We conducted a retrospective review over 20 years on 35 patients with SCI with chronic recurrent end-stage stage IV pressure ulcers between 1991 and 2014. All patients underwent excision of the primary pressure ulcer with immediate total thigh flap reconstruction.
RESULTS: 35 patients underwent hip disarticulation with immediate total thigh flap for recurrent chronic trochanteric, sacral, perineal, ischial, and pelvic stage IV pressure ulcers.16 patients developed intraoperative and postoperative complications which included intraoperative blood loss and superficial flap dehiscence.14 of the patients with superficial flap dehiscence were salvaged with local wound care alone with 2 patients needing revision for surgical correction.
CONCLUSION: Total thigh flap is a lifesaving procedure in the SCI patient with multiple recurrent ulcers involving the perineum and pelvis. With limited reserve of muscle and skin in the lower extremity and pelvis, total thigh flap is a viable option to create soft tissue padding over the bony structures left in the pelvis in the SCI patient with proper patient selection, preoperative urinary and bowel diversion. Our study demonstrates that total thigh flap in SCI patients with complex end-stage perinoeopelvic ulcers heal well and resume wheelchair sitting with overall improved quality of life.


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