The operative treatment of pressure sores in the pelvic region: A 10-year period overview.

CONTEXT: Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. METHODS: A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. RESULTS: We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. CONCLUSION: The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

[Experiences with Tenckhoff peritoneal dialysis catheter]. / Peritonealis dializáló katéter (Tenckhoff) beültetésével kapcsolatos tapasztalataink.

UNLABELLED: Peritoneal dialysis is a generally accepted method for the treatment of patients with end-stage renal disease. Two main techniques for the insertion of the peritoneal catheter are known: open surgery and the laparoscopic-assisted technique. AIM: To describe our surgical procedure and implantation technique and to determine the outcome of our patients who underwent the conventional and the laparoscopic assisted placement of a catheter. METHODS: Between September 2001 and June 2009, 124 patients underwent either conventional or laparoscopic peritoneal dialysis catheter insertion procedure. RESULTS: 52 male, and 70 female patients were studied (mean age: 62 years), 110 conventional and 14 laparoscopic assisted operation were done. CONCLUSIONS: The traditional method for placement of peritoneal dialysis catheters is by "blind" insertion of the catheter through a small lower abdominal incision. The laparoscopic placement is a new but well-established technique and offers some advantages, such as a safer and accurate placement of the catheter under direct vision, less postoperative pain and complications, and a longer functional survival, compared to the conventional open technique. The functional outcome of the catheters was satisfactory in the majority of patients in this study. The conventional technique is simple, safe and has low costs, and in our opinion, it should be used for the most times, and the laparoscopic technique should be considered as the method of special choice in patients with end-stage chronic renal failure.

Clinical experience with the hatchet-shaped gluteus maximus musculocutaneous flap.

One of the most frequently used flaps for the coverage of sacral skin and soft-tissue defects (primarily decubiti) is the gluteus maximus musculocutaneous flap. The authors have developed a new, hatchet-shaped incision direction for the flap and have been using it for 6 years in the surgical treatment of various pelvic-area defects with good results. At the beginning, the gluteus maximus hatchet-shaped flap was used for treatment of pressure sores in the pelvic area: sacral decubitus on 31 patients, ischial pressure ulcer on 12 patients, and trochanteric ulcer on 1 patient. However, later the method was applied to nondecubitus defects, such as myelomeningocele on 4 patients, Crohn disease on 3 patients, pilonidal sinus on 2 patients, and traumatic defect on 1 patient, totaling 71 flaps on 54 patients. The seroma (4), hematoma (2), postoperative bleeding (1), and partial flap necrosis (1) healed following emptying and repeated surgery; recurrent ulcer was seen in 2 cases. Advantages of the method are the fewer incisions needed, the shorter operating time, and the smaller blood loss as compared with the methods known so far. The new incision direction improves the safety of circulation in the flap, the closure of the donor site is simpler, and no contour difference remains in the surgical area.

[Surgical treatment of decubitus ulcers of the pelvic area in patients with spinal cord injury]. / A medencetájéki decubitusok mütéti kezelése gerincvelösérült betegeknél.

Pressure sores in spinal cord-injured patients can be treated by either conservative or surgical methods. Shortened healing period and long lasting results can be achieved by surgery. Between 1993 and 2001 the authors performed 64 operations with musculocutaneous or musculo-fasciocutaneous flaps in all cases. All patients healed primary except one, whose 20-year-old pressure sore transformed malignant and gave metastasis. The complication rate was 21.42%, that equals with the data of the literature. Measuring the late postoperative results by follow-up questionnaire, a 9.52% ratio of recurrence was found, which was significantly smaller than data of the literature (19-82%). Authors analyse the causes of their (good) results.

[15 years experience in the surgical treatment of decubitus ulcers of the pelvic region]. / 15 éves tapasztalataink a medencetájéki decubitusok mútéti kezelésében.

We summarize our 15 year experience in the surgical treatment of pressure ulcers of the pelvic region. The technique of suggested operations is described (sacral defect--gluteus maximus musculocutaneous V-Y advancement flap, trochanteric defect--tensor fascia lata musculofasciocutaneous transpositional flap, ischial defect--biceps femoris musculocutaneous V-Y advancement flap). In recent years we cover defects in all these regions using the principle of Emmett's hatchet flap--i.e. with musculocutaneous hatchet flap. We performed 105 operations, 3 patients had recurrence.