Current Problems in Surgery
Volume 44, Issue 2 , Pages 101-143 , February 2007

Pressure Sores

  • Michael J. Bass, MD, JD

      Affiliations

    • Resident in Plastic Surgery, University of Texas Medical Branch, Galveston, TX
  • ,
  • Linda G. Phillips, MD

      Affiliations

    • Truman G. Blocker, Distinguished Professor and Chair, Chief, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, TX

References 

  1. Bergstrom N, Bennett A, Carlson CE, et al. Pressure ulcer treatment: a critical practice guideline. In: AHCPR Pub No 95-0653. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994;
  2. Petersen NC, Bittmann S. The epidemiology of pressure sores. Scand J Plast Reconstr Surg. 1971;5:62–66
  3. Capezuti EA, Braun JA. Medico-legal aspects of hospital siderail use. In:  Kapp MB editors. Ethics, Law, and Aging Review. New York: Springer Publishing; 2001;p. 25–57
  4. Bass MJ. Risk management, health care, and the geriatric patient population. In:  Kapp MB editors. Ethics, Law, and Aging Review. New York: Springer Publishing; 2001;p. 11–24
  5. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients (Results of the Harvard Medical Practice Study II). N Engl J Med. 1991;324:377–384
  6. Lindan O, Greenway RM, Piazza JM. Pressure distribution on the surface of the human body (I. Evaluation in lying and sitting positions using a “bed of springs and nails”). Arch Phys Med Rehabil. 1965;46:378–385
  7. http://www.guinnessworldrecords.com/. Accessed December 13, 2005.
  8. Kosiak M, Kubicek WG, Olson M, Danz JN, Kottke FJ. Evaluation of pressure as a factor in the production of ischial ulcers. Arch Phys Med Rehabil. 1958;39:623–629
  9. Dinsdale SM. Decubitus ulcers: role of pressure and friction in causation. Arch Phys Med Rehabil. 1974;55:147–152
  10. Husain T. An experimental study of some pressure effects on tissues, with reference to the bed-sore problem. J Pathol Bacteriol. 1953;66:347–358
  11. Abu-Rustum NR, Rajbhandari D, Glusman S, Massad LS. Acute lower extremity paralysis following radiation therapy for cervical cancer. Gynecol Oncol. 1999;75:152–154
  12. Buchan AC, Fulford GE, Harris P, Jellinek E, Kerr WG, Kirkland I, et al. A preliminary survey of the incidence and aetiology of spinal paralysis. Paraplegia. 1972;10:23–28
  13. Johnson KL, Cheung RB, Johnson SB, Roberts M, Niblett J, Manson D. Therapeutic paralysis of critically ill trauma patients: perceptions of patients and their family members. Am J Crit Care. 1999;8:490–498
  14. Rotondo MF, McGonigal MD, Schwab CW, Kauder DR, Hanson CW. Urgent paralysis and intubation of trauma patients: is it safe?. J Trauma. 1993;34:242–246
  15. Shindle MK, Khanna AJ, McCarthy EF, O′Neill PJ, Sponseller PD. Desmoid tumor of the spinal canal causing scoliosis and paralysis. Spine. 2002;27:E304–E307
  16. Solomon T, Willison H. Infectious causes of acute flaccid paralysis. Curr Opin Infect Dis. 2003;16:375–381
  17. Rohland BM, Carroll BT, Jacoby RG. ECT in the treatment of the catatonic syndrome. J Affect Disord. 1993;29:255–261
  18. Greenberg MS. Handbook of Neurosurgery. New York: Thieme Medical Publishers; 2001;
  19. Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964;192:540–542
  20. Brown TR, Kraft GH. Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehabil Clin N Am. 2005;16:513–555
  21. Wang RY, Chen HI, Chen CY, Yang YR. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin Rehabil. 2005;19:155–164
  22. Maruyama T, Behrends JC, Akaike N. Inhibition of the voltage-dependent calcium currents in isolated frog sensory neurons by GABA-related agonistic compounds. Neurosci Res. 1988;6:97–105
  23. Zhao F, Li P, Chen SR, Louis CF, Fruen BR. Dantrolene inhibition of ryanodine receptor Ca2+ release channels (Molecular mechanism and isoform selectivity). J Biol Chem. 2001;276:13810–13816
  24. Fares Y, Khazim RM, del Barrio ER, Burzaco JA. Dosage of intrathecal baclofen maintenance therapy in the spastic syndromes. J Med Liban. 2004;52:13–18
  25. Albright AL, Awaad Y, Muhonen M, Boydston WR, Gilmartin R, Krach LE, et al. Performance and complications associated with the synchromed 10-ml infusion pump for intrathecal baclofen administration in children. J Neurosurg. 2004;101:64–68
  26. Garland DE, Lucie RS, Waters RL. Current uses of open phenol nerve block for adult acquired spasticity. Clin Orthop Relat Res. 1982;217–222
  27. Herz DA, Looman JE, Tiberio A, Ketterling K, Kreitsch RK, Colwill JC, et al. The management of paralytic spasticity. Neurosurgery. 1990;26:300–306
  28. Sindou M, Millet MF, Mortamais J, Eyssette M. Results of selective posterior rhizotomy in the treatment of painful and spastic paraplegia secondary to multiple sclerosis. Appl Neurophysiol. 1982;45:335–340
  29. Jani P, Trice J, Umejiego C. http://www.arches.uga.edu/∼pjani/Chioma.html. Accessed June 16, 2005.
  30. Larson E. Skin hygiene and infection prevention: more of the same or different approaches?. Clin Infect Dis. 1999;29:1287–1294
  31. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002;23:S3–S40
  32. Howard JM, Barker WF, Culbertson WR, et al. Post-operative wound infections: the influence of ultra-violet radiation of the operating rooms and various other factors. Ann Surg. 1964;160:32–81
  33. Groth K. Klinische Beobachtungen und experimentelle Studien uber die Enstehung des Dekubitis. Acta Chir Scand. 1942;87:1–209
  34. Robson MC, Krizek TJ. The role of infection in chronic pressure ulcerations (Symposium on Neurologic Aspects of Plastic Surgery). St Louis: CV Mosby; 1978;
  35. Howe CW. Experimental wound sepsis from transient bacteremia. Surg Gynecol Obstet. 1968;126:1066–1070
  36. Landis EM. Micro-injection studies of capillary blood pressure in human skin. Heart. 1930;15:209–228
  37. Exton-Smith AN, Crockett DJ. Nature of oedema in paralysed limbs of hemiplegic patients. BMJ. 1957;3:1280–1283
  38. Ho TL, Lee KW, Lee HJ. Subacute mandibular and hypoglossal nerve denervation causing oedema of the masticator space and tongue. Neuroradiology. 2003;45:262–266
  39. Bredella MA, Tirman PF, Fritz RC, Wischer TK, Stork A, Genant HK. Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol. 1999;28:567–572
  40. Chen LE, Seaber AV, Urbaniak JR. Combined effect of acute denervation and ischemia on the microcirculation of skeletal muscle. J Orthop Res. 1992;10:112–120
  41. Alison WE, Phillips LG, Linares HA, Hui PS, Hayward PG, Broemeling LD, et al. The effect of denervation on soft-tissue infection pathophysiology. Plast Reconstr Surg. 1992;90:1031–1035
  42. Henriksen O, Sejrsen P, Paaske WP, Eickhoff JH. Effect of chronic sympathetic denervation upon the transcapillary filtration rate induced by venous stasis. Acta Physiol Scand. 1983;117:171–176
  43. Levenson SM, Demetriou AA. Metabolic factors. In:  Cohen IK,  Diegelmann RF,  Linblad WL editor. Wound Healing: Biochemical and Clinical Aspects. Philadelphia: WB Saunders; 1993;
  44. Dickerson RN, Gervasio JM, Riley ML, Murrell JE, Hickerson WL, Kudsk KA, et al. Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients. JPEN J Parenter Enteral Nutr. 2002;26:17–29
  45. Mandt J, Teasley-Strausburg K, Shronts E. Nutritional requirements. In:  Teasley-Strausburg K editors. Nutritional Support Handbook. Cincinnati: Harvey Whitney Books; 1992;
  46. Fuhrman MP. The albumin-nutrition connection: separating myth from fact. Nutrition. 2002;18:199–200
  47. Golden MH, Golden BE. Severe malnutrition. In:  Garrow JS,  James WPT,  Ralph A editor. Human nutrition and dietetics. Edinburgh: Churchill Livingstone; 2000;p. 515
  48. Lim SH, Lee JS, Chae SH, Ahn BS, Chang DJ, Shin CS. Prealbumin is not sensitive indicator of nutrition and prognosis in critical ill patients. Yonsei Med J. 2005;46:21–26
  49. Burns JL, Mancoll JS, Phillips LG. Impairments to wound healing. In:  Phillips LG editors. Clinics in Plastic Surgery. Philadelphia: WB Saunders; 2003;p. 47–56
  50. Ehrlich HP, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg. 1968;167:324–328
  51. Lioupis C. Effects of diabetes mellitus on wound healing: an update. J Wound Care. 2005;14:84–86
  52. Collins N. Diabetes, nutrition, and wound healing. Adv Skin Wound Care. 2003;16:291–294
  53. Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30:37–45
  54. Komesu MC, Tanga MB, Buttros KR, Nakao C. Effects of acute diabetes on rat cutaneous wound healing. Pathophysiology. 2004;11:63–67
  55. Fahey TJ, Sadaty A, Jones WG, Barber A, Smoller B, Shires GT. Diabetes impairs the late inflammatory response to wound healing. J Surg Res. 1991;50:308–313
  56. Robson MC, Heggers JP. Effect of hyperglycemia on survival of bacteria. Surg Forum. 1969;20:56
  57. Yeoman MP, Hardy AG. The pathology and treatment of pressure sores in paraplegics. Br J Plast Surg. 1954;7:179–192
  58. Dansereau JG, Conway H. Closure of decubiti in paraplegics (Report of 2000 cases). Plast Reconstr Surg. 1964;33:474–480
  59. Yeoman MP, Hardy AG. The pathology and treatment of pressure sores in paraplegics. Br J Plast Surg. 1954;7:179–192
  60. Dansereau JG, Conway H. Closure of decubiti in paraplegics (Report of 2000 cases). Plast Reconstr Surg. 1964;33:474–480
  61. Daniel RK, Priest DL, Wheatley DC. Etiologic factors in pressure sores: an experimental model. Arch Phys Med Rehabil. 1981;62:492–498
  62. Nola GT, Vistnes LM. Differential response of skin and muscle in the experimental production of pressure sores. Plast Reconstr Surg. 1980;66:728–733
  63. Daniel RK, Faibisoff B. Muscle coverage of pressure points—the role of myocutaneous flaps. Ann Plast Surg. 1982;8:446–452
  64. Krupp S, Kuhn W, Zaech GA. The use of innervated flaps for the closure of ischial pressure sores. Paraplegia. 1983;21:119–126
  65. Braden BJ, Bergstrom N. Clinical utility of the Braden scale for predicting pressure sore risk. Decubitus. 1989;2:44–51
  66. Stauffer ES. Rehabilitation of post-traumatic cervical spinal cord-quadriplegia and paraplegia. In:  Bailey R editors. The cervical spine. Philadelphia: JB Lippincott; 1983;
  67. Ungar GH. The care of the skin in paraplegia. Practitioner. 1971;206:507–512
  68. Linares HA, Mawson AR, Suarez E, Biundo JJ. Association between pressure sores and immobilization in the immediate post-injury period. Orthopedics. 1987;10:571–573
  69. Mawson AR, Biundo JJ, Neville P, Linares HA, Winchester Y, Lopez A. Risk factors for early occurring pressure ulcers following spinal cord injury. Am J Phys Med Rehabil. 1988;67:123–127
  70. Mullins CD, Philbeck TE, Schroeder WJ, Thomas SK. Cost effectiveness of kinetic therapy in preventing nosocomial lower respiratory tract infections in patients suffering from trauma. Managed Care Interface. 2002;15:35–40
  71. Raoof S, Chowdhrey N, Raoof S, Feuerman M, King A, Sriraman R, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest. 1999;115:1658–1666
  72. Vasconez LO, Schneider WJ, Jurkiewicz MJ. Pressure sores. In: Current Problems in Surgery. 14:Chicago: Year Book Medical Publishers; 1977;p. 1–62
  73. Berecek KH. Treatment of decubitus ulcers. Nurs Clin North Am. 1975;10:171–210
  74. Robson MC. Difficult wounds: pressure ulcerations and leg ulcers. Clin Plast Surg. 1979;6:537–540
  75. Robson MC, Edstrom LE, Krizek TJ, Groskin MG. The efficacy of systemic antibiotics in the treatment of granulating wounds. J Surg Res. 1974;16:299–306
  76. Lashner BA, Todorczuk J, Sahm DF, Hanauer SB. Clostridium difficile culture-positive toxin-negative diarrhea. Am J Gastroenterol. 1986;81:940–943
  77. Deshmukh GR, Barkel DC, Sevo D, Hergenroeder P. Use or misuse of colostomy to heal pressure ulcers. Dis Colon Rectum. 1996;39:737–738
  78. Jensen JA, Goodson WH, Hopf HW, Hunt TK. Cigarette smoking decreases tissue oxygen. Arch Surg. 1991;126:1131–1134
  79. Reus WF, Colen LB, Straker DJ. Tobacco smoking and complications in elective microsurgery. Plast Reconstr Surg. 1992;89:490–494
  80. Morgan JE. Topical therapy of pressure ulcers. Surg Gynecol Obstet. 1975;141:945–947
  81. Kucan JO, Robson MC, Heggers JP, Ko F. Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers. J Am Geriatr Soc. 1981;29:232–235
  82. Daltrey DC, Rhodes B, Chattwood JG. Investigation into the microbial flora of healing and non-healing decubitus ulcers. J Clin Pathol. 1981;34:701–705
  83. Colen SR. Pressure sores. In:  McCarthy JG editors. Plastic Surgery. Philadelphia: WB Saunders; 1991;p. 3797–3838
  84. Robson MC, Phillips LG, Thomason A, Robson LE, Pierce GF. Platelet-derived growth factor BB for the treatment of chronic pressure ulcers. Lancet. 1992;339:23–25
  85. Robson MC, Phillips LG, Thomason A, Altrock BW, Pence PC, Heggers JP, et al. Recombinant human platelet-derived growth factor-BB for the treatment of chronic pressure ulcers. Ann Plast Surg. 1992;29:193–201
  86. Robson MC, Abdullah A, Burns BF, et al. Safety and effect of topical recombinant human interleukin-1B in the management of pressure sores. Wound Repair Regen. 1994;2:177–181
  87. Phillips LG, Abdullah KM, Geldner PD, Dobbins S, Ko F, Linares HA, et al. Application of basic fibroblast growth factor may reverse diabetic wound healing impairment. Ann Plast Surg. 1993;31:331–334
  88. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563–576
  89. Weed T, Ratliff C, Drake DB. Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance?. Ann Plast Surg. 2004;52:276–279
  90. Moues CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen. 2004;12:11–17
  91. Harlan JW. Treatment of open sternal wounds with the vacuum-assisted closure system: a safe, reliable method. Plast Reconstr Surg. 2002;109:710–712
  92. Garner GB, Ware DN, Cocanour CS, Duke JH, McKinley BA, Kozar RA, et al. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg. 2001;182:630–638
  93. Schimp VL, Worley C, Brunello S, Levenback CC, Wolf JK, Sun CC, et al. Vacuum-assisted closure in the treatment of gynecologic oncology wound failures. Gynecol Oncol. 2004;92:586–591
  94. Scherer LA, Shiver S, Chang M, Meredith JW, Owings JT. The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg. 2002;137:930–933
  95. DeFranzo AJ, Marks MW, Argenta LC, Genecov DG. Vacuum-assisted closure for the treatment of degloving injuries. Plast Reconstr Surg. 1999;104:2145–2148
  96. Josty IC, Ramaswamy R, Laing JH. Vacuum assisted closure: an alternative strategy in the management of degloving injuries of the foot. Br J Plast Surg. 2001;54:363–365
  97. Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum-assisted closure device. Ann Plast Surg. 2001;47:552–554
  98. Fisher A, Brady B. Vacuum assisted wound closure therapy. Issues Emerg Health Technol. 2003;44:1–6
  99. Sibbald RG, Mahoney J, Group VACTCC. A consensus report on the use of vacuum-assisted closure in chronic, difficult-to-heal wounds. Ostomy Wound Manage. 2003;49:52–66
  100. Miller Q, Bird E, Bird K, Meschter C, Moulton MJ. Effect of subatmospheric pressure on the acute healing wound. Curr Surg. 2004;61:205–208
  101. Dieu T, Leung M, Leong J, Morrison W, Cleland H, Archer B, et al. Too much vacuum-assisted closure. ANZ J Surg. 2003;73:1057–1060
  102. Tabor OB, Bosse MJ, Hudson MC, Greene KG, Nousiainen MT, Meyer RA, et al. Does bacteremia occur during high pressure lavage of contaminated wounds?. Clin Orthop. 1998;117–121
  103. Boyd JI, Wongworawat MD. High-pressure pulsatile lavage causes soft tissue damage. Clin Orthop. 2004;13–17
  104. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop. 2005;27–31
  105. Burke JF. Preventive antibiotic management in surgery. Annu Rev Med. 1973;24:289–294
  106. Miles AA, Miles EM, Burke J. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol. 1957;38:79–96
  107. Jennings SA, Robson MC, Jennings MM. Preventing wound infection from distant endogenous sources in the rat. J Surg Res. 1977;22:16–22
  108. Jones NF, Wexler MR. Delineation of the pressure sore bursa using methylene blue and hydrogen peroxide. Plast Reconstr Surg. 1981;68:798–799
  109. Conway H. The plastic surgical closure of decubitus ulcers in patients with paraplegia. Surg Gynecol Obstet. 1947;85:321–322
  110. Bruck JC, Buttemeyer R, Grabosch A, et al. More arguments in favor of myocutaneous flaps for the treatment of pelvic pressure sores. Ann Plast Surg. 1991;26:85
  111. Findlay GM. Histamine and infection. J Pathol Bacteriol. 1928;31:633
  112. Hill HL, Brown RG, Jurkiewicz MJ. The transverse lumbosacral back flap. Plast Reconstr Surg. 1978;62:177–184
  113. Ger R. The surgical management of ulcerative lesions of the leg. In:  Ravitch MM editors. Current Problems in Surgery. Chicago: Year Book Medical Publishers; 1972;
  114. Ger R, Levine SA. The management of decubitus ulcer by muscle transposition: an 8-year review. Plast Reconstr Surg. 1976;58:419–428
  115. Vasconez LO, Bostwick J, McCraw J. Coverage of exposed bone by muscle transposition and skin grafting. Plast Reconstr Surg. 1974;53:526–530
  116. Vasconez LO, McCraw JB. The use of muscle in plastic and reconstructive surgery. In:  Krizek TJ,  Hoopes J editor. Symposium on Applications of Basic Science to Plastic Surgery. St Louis: CV Mosby; 1976;
  117. Coskunfirat OK, Ozgentas HE. Gluteal perforator flaps for coverage of pressure sors at various locations. Plast Reconstr Surg. 2004;113:2012–2017
  118. Lee HB, Kim SW, Lew DH, Shin KS. Unilateral multilayered musculocutaneous V-Y advancement flap for the treatment of pressure sore. Plast Reconstr Surg. 1997;100:340–349
  119. Leow M, Lim J, Lim TC. The superior gluteal artery perforator flap for the closure of sacral sores. Singapore Med J. 2004;45:37–39
  120. Borman H, Maral T. The gluteal fasciocutaneous rotation-advancement flap with V-Y closure in the management of sacral pressure sores. Plast Reconstr Surg. 2002;109:2325–2329
  121. Conway H, Griffith BH. Plastic surgery for closure of decubitus ulcers in patients with paraplegia; based on experience with 1,000 cases. Am J Surg. 1956;91:946–975
  122. Blocksma R, Kostrubala JG, Greeley PW. The surgical repair of decubitis ulcers. Plast Reconstr Surg. 1947;2:403
  123. Arregui J, Cannon B, Murray JE, O′Leary JJ. Long-term evaluation of ischiectomy in the treatment of pressure ulcers. Plast Reconstr Surg. 1965;36:583–590
  124. Karaca AR, Binns JH, Blumenthal FS. Complications of total ischiectomy for the treatment of ischial pressure sores. Plast Reconstr Surg. 1978;62:96–99
  125. Eltorai I, Khonsari F, Montroy R, Comarr AE. Urinary fistulae after radical ischiectomies in surgery of ischial pressure sores. Paraplegia. 1985;23:379–385
  126. Hackler RH, Zampieri TA. Urethral complications following ischiectomy in spinal cord injury patients: a urethral pressure study. J Urol. 1987;137:253–255
  127. Culkin DJ, Wheeler JS, Chintam R, Lopez E, Nemchausky BA. Perineal urethrocutaneous fistula complicating ischiectomy. J Urol. 1988;139:811–812
  128. Nahai F, Silverton JS, Hill HL, Vasconez LO. The tensor fascia lata musculocutaneous flap. Ann Plast Surg. 1978;1:372–379
  129. Hurwitz DJ, Swartz WM, Mathes SJ. The gluteal thigh flap: a reliable, sensate flap for the closure of buttock and perineal wounds. Plast Reconstr Surg. 1981;68:521–532
  130. Tavakoli K, Rutkowski S, Cope C, Hassall M, Barnett R, Richards M, et al. Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study. Br J Plast Surg. 1999;52:476–479
  131. Josvay J, Donath A. Modified hamstring musculocutaneous flap for the coverage of ischial pressure sores. Plast Reconstr Surg. 1999;103:1715–1718
  132. Berger SR, Rubayi S, Griffin AC. Closure of multiple pressure sores with split total thigh flap. Ann Plast Surg. 1994;33:548–551
  133. Jones JW. Reinnervated medial gastrocnemius free flap for closure of a recurrent ischial pressure sore: case report. J Reconstr Microsurg. 2002;18:397–400
  134. Hallock GG. Closure of an ischial pressure sore using a free gastrocnemius musculocutaneous flap with a long venous pedicle. Br J Plast Surg. 1995;48:504–506
  135. Higgins JP, Orlando GS, Blondeel PN. Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg. 2002;55:83–85
  136. Homma K, Murakami G, Fujioka H, Fujita T, Imai A, Ezoe K. Treatment of ischial pressure ulcers with a posteromedial thigh fasciocutaneous flap. Plast Reconstr Surg. 2001;108:1990–1997
  137. Josvay J, Sashegyi M, Kelemen P, Donath A. Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores. Br J Plast Surg 2005 (PMID: 16309648).
  138. Dibbell DG, McCraw JB, Edstrom LE. Providing useful and protective sensibility to the sitting area in patients with meningomyelocele. Plast Reconstr Surg. 1979;64:796–799
  139. Gabapentin (Neurontin) for chronic pain. Med Lett Drugs Ther. 2004;46:29–31
  140. Gay S, Egon G. [Spasticity (Physical therapy, preventive measures and treatment]). Ann Fr Anesth Reanim. 2005;24:663–666
  141. Roth RS, Lowery JC, Hamill JB. Assessing persistent pain and its relation to affective distress, depressive symptoms, and pain catastrophizing in patients with chronic wounds: a pilot study. Am J Phys Med Rehabil. 2004;83:827–834

PII: S0011-3840(06)00119-5

doi: 10.1067/j.cpsurg.2006.12.007

Current Problems in Surgery
Volume 44, Issue 2 , Pages 101-143 , February 2007