Ischial pressure ulcers: long-term outcome of 2 surgical techniques.

BACKGROUND: The aim of our study was to analyze which of these 2 techniques (biceps femoris myocutaneous flap vs gluteus maximus myocutaneous flap) gave the best result for ischial pressure ulcers treatment. METHODS: A retrospective comparative analysis of medical records for stage III and IV pressure ulcers was conducted between the 2 groups by Fisher exact test for categorical variables (significance level P <0.05) followed by a survival analysis by the Kaplan-Meier method. RESULTS: Twenty-five patients were treated with biceps femoris flap against 8 patients with gluteus maximus flap, primary healing was obtained without complications in 32% of cases in biceps femoris group versus 62.5% in gluteus maximus group. No surgical techniques were statistically correlated with a lower recurrence (32% vs 0%, P = 0.152). CONCLUSIONS: We had no significant difference in recurrence rate between the 2 flaps. However, we had less morbidity in gluteus maximus flap group; indeed, we had zero rate of reoperation and a zero rate of recurrence. For that reason, we think that gluteus maximus flap seems to be the best technical coverage of ischial pressure ulcers.

Fibrin sealant decreases postoperative drainage in immediate breast reconstruction by deep inferior epigastric perforator flap after mastectomy with axillary dissection.

BACKGROUND: Serosanguinous drainage after breast reconstruction by deep inferior epigastric perforator flap (DIEP) can limit patient's discharge. We introduced fibrin sealant in immediate breast reconstruction by DIEP flap to reduce drainage after mastectomy with axillary dissection. MATERIALS AND METHODS: We performed an open study on 30 consecutive female aged from 28 to 63 years old. All underwent immediate breast reconstructions by DIEP flaps after mastectomy and axillary dissection for cancer. Patients were divided in group 1 (N = 15) without fibrin sealant and group 2 (N = 15) where the flap, thoracic, and axillary areas were sprayed with 5 mL of liquid fibrin sealant before drains insertion. There was no difference in the patient's BMI, height, weight or age between both the groups. Blake suction drains were placed under the flap and in the axillary area. RESULTS: No adverse effects were reported, after a 20-month median follow-up. Drainage volumes or durations were not correlated to the patient's BMI, nor the height, weight or age. Thoracic drainage duration was longer than abdominal drainage in both the groups. Average drained volumes from the thoracic area were lower (427 vs. 552 mL; P = 0.015) and thoracic drains were removed earlier (5.47 vs. 6.33 days P = 0.022), in group 2 than in group 1. The length of stay was also reduced after the use of fibrin sealant (5.53 vs. 6.33 days; P = 0.032). CONCLUSION: This study introduce the interest of fibrin sealant to significantly decrease the postoperative drainage volume and duration in the thoracic area after immediate breast reconstruction by DIEP flap.