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Surgical Management

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The Decubitus Ulcer in Clinical Practice

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Abstract

The ultimate goal in the treatment of decubitus ulcers is to obtain a closed, healed wound that resists recurrence. The surgical means to this end evolved in the period during and following World War II when surgeons were faced with large numbers of casualties with spinal cord injuries. Prior to that time, the treatment was essentially nonsurgical. This evolution in our modern concept of the surgery of decubitus ulcers occurred in three overlapping but relatively distinct phases:

  1. Phase 1.

    Techniques to obtain wound closure were devised. These included the use of skin grafts and flaps alone or in combination with the eventual recognition that a large padded flap would be most reliable and suitable for wound coverage and long-term durability. This evolution in our modern concept of the surgery of decubitus ulcers occurred in three overlapping but relatively distinct phases:

  2. Phase 2.

    The role played by the underlying bony prominence in the pathophysiology of the ulceration was recognized. Ostectomy was added to the procedures in an attempt to reduce the risk of continued pressure or retained foci of infection.

  3. Phase 3.

    The design of flaps became more sophisticated through a clearer understanding of their vascular anatomy and physiology producing a second generation of flaps, the arterialized flaps.

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References

  1. Davis JS (1938) Operative treatment of scars following bedsores. Surgery 3:1–7

    Google Scholar 

  2. Lamon JG and Alexander EJ (1945) Secondary closure of decubitus ulcers with aid of penicillin. JAMA 127:396

    Google Scholar 

  3. Bailey BN (1967) Bedsores. Arnold, London

    Google Scholar 

  4. White JC, Hudson HW, Kennard HE (1945) The treatment of bedsores by total excision with plastic closure. US Naval Med Bull 45:445–463

    Google Scholar 

  5. Barker DE (1945) The surgical treatment of decubitus ulcers. JAMA 129:160

    Google Scholar 

  6. Croce EJ, Schillinger RN, Shearer TP (1946) Operative treatment of decubitus ulcer. Ann Surg 123:53–69

    Article  Google Scholar 

  7. Gibbon JH, Freeman LW (1946) The primary closure of decubitus ulcers. Ann Surg 124:1148–1164

    Article  CAS  Google Scholar 

  8. Barker DE, Elkins C, Poer D (1946) Methods of closure of decubitus ulcers in paralyzed patients. Ann Surg 123:523–533

    Article  Google Scholar 

  9. White JC, Hamm WG (1946) Primary closure of bed sores by plastic surgery. Ann Surg 124:1136–1147

    Article  Google Scholar 

  10. Croce EJ, Beakes CHC (1947) The operative treatment of decubitus ulcer. N Engl J Med 237:141–149

    Article  PubMed  CAS  Google Scholar 

  11. Conway H, Kraissl CJ, Clifford RH et al. (1947) The plastic surgical closure of decubitus ulcers in patients with paraplegia. Surg Gynecol Obstet 85:321–332

    PubMed  CAS  Google Scholar 

  12. Kostrubala JC, Greeley PW (1947) The problem of decubitus ulcers in paraplegics. Plast Reconstr Surg 2:403–412

    Article  CAS  Google Scholar 

  13. Blocksma R, Kostrubala J, Greeley P (1949) The surgical repair of decubitus ulcers in paraplegics. Plast Reconstr Surg 4:123–132

    Article  CAS  Google Scholar 

  14. Conway H, Stark RB, Weeter JC et al. (1951) Complications of decubitus ulcers in patients with paraplegia. Plast Reconstr Surg 7:117–130

    Article  CAS  Google Scholar 

  15. Comarr AE, Bors E (1951) Radical ischiectomy in decubitus ischial ulcers in patients with paraplegia. Ann W Med Surg 5:210–213

    CAS  Google Scholar 

  16. Comarr AE, Bors E (1958) Perineal urethral diverticulum — complication of removal of ischium. JAMA 168:2000–2003

    CAS  Google Scholar 

  17. Guthrie RH, Conway H (1969) Surgical management of decubitis ulcers in paraplegics. In: Proceedings of the 17th V A spinal cord injury conference. Bronx, NY 29 Sept-1 Oct 1969

    Google Scholar 

  18. Gordon S (1947) The surgical treatment of pressure sores. Plast Reconstr Surg 2:557–562

    Article  CAS  Google Scholar 

  19. Campbell RM, Converse JM (1954) The saddle flap for surgical repair of ischial decubitus ulcers. Plast Reconstr Surg 14:442–443

    Article  CAS  Google Scholar 

  20. Bors E, Comarr AE (1948) Ischial decubitus ulcer. Surgery 24:680–694

    PubMed  CAS  Google Scholar 

  21. Conway H, Griffith BH (1956) Plastic surgery for closure of decubitus ulcers in patients with paraplegia. Am J Surg 91:946–975

    Article  PubMed  CAS  Google Scholar 

  22. Ger R (1971) The surgical management of decubitus ulcers by muscle transposition. Surgery 69:106–110

    PubMed  CAS  Google Scholar 

  23. Ger R (1975) The surgical management of ulcers of the heel. Surg Gynecol Obstet 140:909–911

    PubMed  CAS  Google Scholar 

  24. Stallings JO, Delgado JP, Converse JM (1974) Turn over island flap of gluteus maximus muscle for the repair of sacral decubitus ulcer. Plast Reconstr Surg 54:52–54

    Article  PubMed  CAS  Google Scholar 

  25. Ger R, Levine SA (1976) The management of decubitus ulcers by muscle transposition. Plast Reconstr Surg 58:419–428

    Article  PubMed  CAS  Google Scholar 

  26. Minami RT, Hentz VR, Vistnes LM (1977) Use of vastus lateralis muscle flap for repair of trochanteric pressure sores. Plast Reconstr Surg 60:364–368

    Article  PubMed  CAS  Google Scholar 

  27. Tansini I (1896) Nuovo processo per l’amputazione della mammella per cancro. Reforma Med l(l):3–5

    Google Scholar 

  28. McCraw JB, Massey FM, Shanklin KD et al. (1976) Vaginal reconstruction with gracilis myocutaneous flap. Plast Reconstr Surg 58:176–183

    Article  PubMed  CAS  Google Scholar 

  29. McCraw JB, Dibbeil DG, Carraway JH (1977) Clinical definition of independent myocutaneous vascular territories. Plast Reconstr Surg 60:341–352

    Article  PubMed  CAS  Google Scholar 

  30. Nahai F, Silverton J, Hill HL et al. (1978) The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1:372–379

    Article  PubMed  CAS  Google Scholar 

  31. Minami RT, Mills R, Pardoe R (1977) Gluteus maximus myocutaneous flaps for repair of pressure sores. Plast Reconstr Surg 60:242–249 (Commentary by HB Griffith)

    Google Scholar 

  32. Georgiade N, Pickrell K, Maguire C (1956) Total thigh flap for extensive decubitus ulcers. Plast Reconstr Surg 17:220–225

    Article  CAS  Google Scholar 

  33. Chase RA, White WJ (1959) Bilateral amputation in rehabilitation of paraplegics. Plast Reconstr Surg 24:445–455

    Article  CAS  Google Scholar 

  34. Berkas EM, Chesler MD, Sako Y (1961) Multiple decubitus ulcer treatment by hip disarticulation and soft tissue flaps from the lower limbs. Plast Reconstr Surg 27:618–619

    Article  Google Scholar 

  35. Spira M, Hardy SB (1963) Our experience with high thigh amputations in paraplegics. Plast Reconstr Surg 31:344–352

    Article  PubMed  CAS  Google Scholar 

  36. Weeks PM, Brower TD (1968) Island flap coverage of extensive decubitus ulcers. Plast Reconstr Surg 42:433–436

    Article  PubMed  CAS  Google Scholar 

  37. Royer J, Pickrell K, Georgiade N et al. (1969) Total thigh flaps for extensive decubitus ulcers: a 16-year review of 41 total thigh flaps. Plast Reconstr Surg 44:109–118

    Article  PubMed  CAS  Google Scholar 

  38. Burkhardt BR (1972) An alternative to the total-thigh flap for coverage of massive decubitus ulcers. Plast Reconstr Surg 49:433–438

    Article  PubMed  CAS  Google Scholar 

  39. Dibbeil DG (1974) Use of a long island flap to bring sensation to the sacral area in young paraplegics. Plast Reconstr Surg 54:220–223

    Google Scholar 

  40. Daniel RK, Terzia JK, Cunningham DM (1976) Sensory skin flaps for coverage of pressure sores in paraplegic patients. Plast Reconstr Surg 58:317–328

    Article  PubMed  CAS  Google Scholar 

  41. Mellesi H (1977) Healing of nerves. Clin Plast Surg 4:459–473

    Google Scholar 

  42. Vasconez LO, Schneider WJ, Jurkiewicz MJ (1977) Pressure sores. Curr Probl Surg 14(4):l-62

    Google Scholar 

  43. Mulholland JH, CoTui F, Wright AM et al. (1943) Protein metabolism and bedsores. Ann Surg 118:1015–1023

    Article  PubMed  CAS  Google Scholar 

  44. Dudrick S J, Vars HM, Rhoads JE (1967) Growth of puppies receiving all nutritional requirements by vein. Fortschritt der parenteralen Ernährung, West Germany, pp 1–4

    Google Scholar 

  45. Yeoman MP, Hardy AG (1954) The pathology and treatment of pressure sores in paraplegics. Br J Plast Surg 7:179–192

    Article  PubMed  CAS  Google Scholar 

  46. Dansereau JG, Conway H (1964) Closure of decubiti in paraplegics. Report on 2000 cases. Plast Reconstr Surg 33:474–480

    Article  PubMed  CAS  Google Scholar 

  47. McCraw JB, Myers B, Shanklin KD (1977) The value of fluorescein in predicting the viability of arterialized flaps. Plast Reconstr Surg 60:710–719

    Article  PubMed  CAS  Google Scholar 

  48. Griffith BH, Schultz RC (1961) The prevention and surgical treatment of recurrent decubitus ulcers in patients with paraplegia. Plast Reconstr Surg 27:248–260

    Article  CAS  Google Scholar 

  49. Robson MC (1979) Infection in the surgical patient: an imbalance in the normal equilibrium. Clin Plast Surg 6:493–503

    PubMed  CAS  Google Scholar 

  50. Lopez EM, Aranha GV (1974) The value of sinography in the management of decubitus ulcers. Plast Reconstr Surg 53:208–213

    Article  PubMed  CAS  Google Scholar 

  51. Rocco A, Vandam L (1959) Problems in anesthesia for paraplegics. Anesthesiology 20:348–354

    Article  Google Scholar 

  52. Gronert GA, Theye RA (1975) Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 43:89–99

    Article  PubMed  CAS  Google Scholar 

  53. Tobey RE (1970) Paraplegia, succinylcholine, and cardiac arrest. Anesthesiology 32:359–364

    Article  PubMed  CAS  Google Scholar 

  54. Wesser DRG, Kahn S (1967) The reversed dermis graft in the repair of decubitus ulcers. Plast Reconstr Surg 40:252–254

    Article  PubMed  CAS  Google Scholar 

  55. Daniel RK, Williams HB (1973) The free transfer of skin flaps by microvascular anastomoses. An experimental study and a reappraisal. Plast Reconstr Surg 52:16–31

    Article  PubMed  CAS  Google Scholar 

  56. McCregor I, Morgan G (1973) Axial and random pattern flaps. Br J Plast Surg 26:202–213

    Article  Google Scholar 

  57. Harii K, Ohmori K, Ohmori S (1974) Successful clinical transfers of ten free flaps by microvascular anastomoses. Plast Reconstr Surg 53:259–270

    Article  PubMed  CAS  Google Scholar 

  58. Daniel RK, Taylor GI (1973) Distant transfer of an island flap by microvascular anastomoses. Plast Reconstr Surg 52:111–117

    Article  PubMed  CAS  Google Scholar 

  59. Landa SJF, Anagnost M, Robson MC (1976) Advances in the surgical treatment of pressure sores. Rev Surg 33:1–4

    PubMed  CAS  Google Scholar 

  60. Cunningham EE, Balu V (1979) Cardiac arrest following fluorescein angiography. JAMA 142:2431

    Article  Google Scholar 

  61. Stein MR, Parker CW (1971) Reactions following intravenous fluorescein. Am J Ophthalmol 72:861–868

    PubMed  CAS  Google Scholar 

  62. Tulenko JF (1967) Surgical treatment of ischial decubitus ulcers with demo-fat flap. Plast Reconstr Surg 40:72–76

    Article  PubMed  CAS  Google Scholar 

  63. Orticochea M (1972) The musculocutaneous flap method: an immediate and heroic substitute for the method of delay. Br J Plast Surg 25:106–110

    Article  PubMed  CAS  Google Scholar 

  64. Dibbell DG, McCraw JB, Edstrom LE (1979) Providing useful and protective sensibility to the sitting area in patients with meningomyelocele. Plast Reconstr Surg 64:796–799

    Article  PubMed  CAS  Google Scholar 

  65. McGregor IA, Jackson I (1972) The groin flap. Br J Plast Surg 25:3–16

    Article  PubMed  CAS  Google Scholar 

  66. Bostwick J (1976) Reconstruction of the heel pad by muscle transposition and split skin graft. Surg Gynecol Obstet 143:973–974

    PubMed  Google Scholar 

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Authors
  1. D. LaRossa
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  2. L. P. Bucky
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Editor information

Editors and Affiliations

  1. Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Lawrence Charles Parish M.D. (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology) (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology)

  2. Yonsei University College of Medicine, Seoul, Korea

    Lawrence Charles Parish M.D. (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology) (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology)

  3. Zagazig University, Zagazig, Egypt. 1819 J.F. Kennedy Boulevard, #465, 19103, Philadelphia, PA, USA

    Lawrence Charles Parish M.D. (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology) (Clinical Professor of Dermatology and Cutaneous Biology and Director of the Jefferson Center for International Dermatology, Visiting Professor of Dermatology, Visiting Professor of Dermatology and Venoreology)

  4. School of Medicine, University of Pennsylvania, 3501 Ryan Avenue, 19136, Philadelphia, PA, USA

    Joseph A. Witkowski M.D. (Clinical Professor of Dermatology, Professor of Dermatology) (Clinical Professor of Dermatology, Professor of Dermatology)

  5. Pennsylvania College of Podiatric Medicine, Philadelphia, Pennsylvania, 3501 Ryan Avenue, 19136, Philadelphia, PA, USA

    Joseph A. Witkowski M.D. (Clinical Professor of Dermatology, Professor of Dermatology) (Clinical Professor of Dermatology, Professor of Dermatology)

  6. University of Southern California School of Medicine, Los Angeles, California, 608 Sierra Madre Boulevard, 91108, San Marino, CA, USA

    John Thorne Crissey M.D. (Clinical Professor of Medicine (Dermatology) (Clinical Professor of Medicine (Dermatology)

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© 1997 Springer-Verlag Berlin Heidelberg

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LaRossa, D., Bucky, L.P. (1997). Surgical Management. In: Parish, L.C., Witkowski, J.A., Crissey, J.T. (eds) The Decubitus Ulcer in Clinical Practice. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60509-3_11

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  • DOI: https://doi.org/10.1007/978-3-642-60509-3_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64436-8

  • Online ISBN: 978-3-642-60509-3

  • eBook Packages: Springer Book Archive

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