Experience with the use of sugar paste dressing followed by reconstruction of sacral pressure sore with V-Y flap: A reliable solution for a major problem

摘要

Pressure sore is a complication in paraplegic/quadriplegic patients. Despite advances in reconstruction techniques, sacral pressure sores are still a challenge to the orthopaedic surgeon, because of long hospital stay resulting into the situation where pressure sores are in evitable for ambulatory patients too. Development of pressure sores makes treatment/rehabilitation difficult and delays treatment options. Additionally, untreated sores cause complications, e.g. death and recurrence after surgery. Attention has been focused on aggressive dressing of the deep sores with use of sugar paste. Once granulation tissue had filled a sore cavity, a surgical closure using V-Y flaps were considered a method providing better treatment results. This study was conducted on 14 patients (10 males and 4 females) with sacral pressure sores in age group of 35 to 80 years. After initial debridement and removal of tissues of doubtful viability, culture and sensitivity were done in all cases. Wounds were packed with sugar paste for 5 to 14 days or till cavity is filled by granulation tissue. Bilateral V-Y myocutaneous flaps were used in 13 cases. Wound gaping occurred in 1 due to failure of a unilateral rotational flap and secondary bilateral V-Y myocutaneous flaps were needed. Suction drains retained for 7 to 10 days and pressure bearing on sores sites was avoided till complete healing. Superficial infection occurred in 3 cases which responded to suction and dressings. In our experience, the use of sugar paste dressing as a preprocedure to V-Y flap covering operation is a reliable options in management of infected deep sacral pressure sore.