The choice of a plastic surgery method for the pressure ulcer of the greater trochanter of the femur in patients with spinal injury

INTRODUCTION. The problem of treating pressure ulcers of the greater trochanter of the femur in patients with consequences of spinal trauma remains the focus of close attention of clinicians and researchers. The complexity of the problem is primarily due to the high percentage of postoperative complications and relapses. The causes of unfavorable treatment outcomes are often defects in preoperative preparation, sometimes – imperfection of the surgical techniques chosen for treatment. Studying the spectrum of complications and predictors of pressure ulcer relapse is necessary for qualitative growth of the effectiveness of surgical treatment.
The OBJECTIVE was to systematize the literature data and, based on the data of our own clinical study, to evaluate the effectiveness of various types of reconstructive plastic surgeries used to close the pressure ulcer of the greater trochanter of the femur in patients with spinal trauma.
METHODS AND MATERIALS. The literature sources focused on surgical treatment of pressure ulcers of the projection of the greater trochanter of the femur were analyzed.
An analysis of surgical treatment of 61 patients who underwent elective surgery for pressure ulcers of the projection of the greater trochanter of the femur was conducted. The following surgical techniques were used: spoke dermotension, plastic surgery with a free split graft, plastic surgery using two types of local skin-fat flaps and a TFL flap.
RESULTS. Analysis of literature data showed that the main method of treating pressure ulcers is surgery. However, the known reconstructive plastic surgeries are far from ideal, since their use leads to such formidable complications as wound infection (from 35 to 50 %), flap ischemia (17 %), flap necrosis (12.5 %), postoperative hematomas, seromas, which are predictors of relapses. In this regard, the «best option» for treating pressure ulcers remains a subject of search.
A prospective study showed that among all operated patients, the most common complications in the postoperative period were flap ischemia, wound infection, suture failure, and lymphorrhea. Such complications were recorded in 21 (34 %) of 61 patients operated on for pressure ulcers of the trochanteric region.
CONCLUSION. The method of choice for treating patients with extensive pressure ulcers is reconstructive plastic surgery, which is based on the formation of skin-fat flaps and rotational skin-fascial flaps with the principles of tension-free plastic surgery. At the same time, the issue of complications such as flap ischemia, lymphorrhea and wound infection remains unresolved, which requires further scientific and practical research.

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