Free flaps for pressure sore coverage

Management of pressure sores still represents a major challenge in plastic surgery practice due to recurrence. The surgeon may have to face multiple or recurrent pressure ulcerations without any local flap left. In this very limited indication, free flap surgery appears to be a useful adjunct in the surgical treatment. We reviewed our charts looking for patients operated for a pressure sore of the sacral, ischial, or trochanteric region. We found 88 consecutive patients representing 108 different pressure sores and 141 flap procedures. Among these patients, 6 presented large sores that could not be covered with a pedicled flap and benefited from free flap surgery (4.2% of all procedures). Stable coverage was achieved in 80% of these patients after a mean follow-up of 32 months. Comparison between pedicled and free flaps groups showed a trend in the latest concerning the presence of diabetes, incontinence, paraplegia, and male sex.