Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years

Sumanas Wanant Jordan, Mauricio De la Garza, Victor L. Lewis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates. Methods A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training. Results Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55–23.3) and deep dehiscence (OR 12.3, 95% CI 1.99–76.9). Conclusions The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer.

Original languageEnglish (US)
Pages (from-to)959-966
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number7
StatePublished - Jul 1 2017


  • Ischial pressure ulcer
  • Muscle flap
  • Osteomyelitis
  • Spinal cord injury

ASJC Scopus subject areas

  • Surgery


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