Management of sacral pressure sores with a myocutaneous flap.

Sacral ulcers usually are caused by pressure leading to pathologic changes in the layers of tissue extending from the skin to the bone. This type of ulcer occurs most commonly in paraplegic or unconscious patients. In a series of 25 patients with sacral pressure sores studied during a one year period of time, the initial management consisted of conservative treatment with excision of the ulcer and daily dressing changes. The results with this method of treatment were satisfactory in ten cases and unsatisfactory in 15 cases. The 15 cases in which the results were unsatisfactory then underwent treatment with operative methods including excision of the ulcer and primary closure, myocutaneous flaps, skin grafting, and transcutaneous skin flaps. In six of ten cases in which a myocutaneous flap was used, the wounds healed satisfactorily. In four cases an infection occurred; in three of these cases the wound healed after infection control, while skin grafting was required for the fourth patient. Overall, the postoperative results with the use of a myocutaneous flap were satisfactory, and the results also were good at follow-up.