Treatment of ischial pressure sores. Our experience of 99 patients
with 108 sores
Charalambos A. Georgiou
Pierre S. Nguyen
Received: 24 May 2014 /Accepted: 18 August 2014 / Published online: 19 September 2014
Springer-Verlag Berlin Heidelberg 2014
Background Ischial pressure sores concern patients in the sitting
position and particularly the rehabilitated patients. Spontaneous
healing may be very difficult without surgery, and ischial pres-
sure sores have the highest recurrence rate among other
decubitus. Furthermore, there is no consensus concerning the
ideal surgical technique in order to definitely treat the patients.
This is a retrospective analysis of the surgical treatment of ischial
pressure sores aiming to identify the ulcer recurrence rate per
surgical technique and describe the early complications.
Methods This was a retrospective study that was conducted in
Marseille, France, between 1988 and 2007. The medical re-
cords concerning patients with ischial pressure sores were
collected and analyzed. The main objective was to identify
the ulcer recurrence rate after ischial pressure sore surgical
treatment. The secondary objective was the identification and
description of early complications.
Results Ninety-nine patients were finally selected and analyzed
for 108 ischial pressure sore treatments. Primary endpoint anal-
ysis identified 25 recurrences for 108 sores (23.14 %). Ham-
string V-Y advancement flap had 71 % recurrence rate. Wound
dehiscence was the primary complication. Six out of seven
hamstring V-Y advancement flaps had early complications.
Conclusions Pressure sore treatment can be difficult and chal-
lenging. In this retrospective study, we have found that the
hamstring V-Y advancement flaps have a much higher recur-
rence rate and a higher rate of complications. Our results may
be limited by the retrospective nature of this study but they
imply that the V-Y advancement flaps should not be used as a
first choice for ischial pressure sore treatment.
Level of Evidence: Level IV, therapeutic study.
Keywords Ischial pressure sores
Gluteus maximus myocutaneous
Pressure sores consist a frequent pathology that the plastic
surgeon is solicited to deal with in the everyday practice.
Ischial pressure sores concern usually patients in the sitting
position and particularly the rehabilitated patients that need
this position in their professional and social life. Very often
this kind of sore is deep, and the bone prominence of the
ischion is exposed. Its dimensions can be easily
underestimated, as the skin defect may be very small making
the sore sinusoid, and very often, spontaneous healing for
these chronic ulcers may be very difficult without surgery.
Care workers consider this kind of decubitus as the most
difficult to cure because of the high recurrence rate . Al-
though Conway and Griffith  initially estimated this rate at
approximately 75 %, it has been more recently decreased to
20 %  as a result of multidisciplinary patient care, preven-
tive equipment, and better treatment protocol. Nevertheless,
ischial pressure sores have the highest recurrence rate among
other pressure sores.
Furthermore, there is no consensus concerning the ideal
surgical technique in order to definitely treat the patients.
C. A. Georgiou
P. S. Nguyen
Plastic, Reconstructive and Aesthetic Surgery Department,
La Conception University Hospital, 147 Boulevard Baille,
13005 Marseille, France
C. A. Georgiou (*)
Plastic Reconstructive and Aesthetic Surgery Department, St Roch
University Hospital of Nice, 5 Pierre Devoluy, 0600 Nice, France
Plastic, Reconstructive and Aesthetic Surgery Department, Hôpital
Nord, University Hospital, Chemin des Bourrely, 13915 Marseille,
Eur J Plast Surg (2014) 37:667–672