Reconstruction of Urethral Defect in Recurred Ischial Pressure Sore Patients

Kim, K S; Lew, D H; Yoo, W M; Park, B Y

Abstract

In paraplegic patients, ischial area is the most vulnerable site to develop pressure sore since the most of the body weight is centered on the tissue overlying the ischial tuberosities in wheelchair ambulation. However the partial or total ischiectomy for management of ischial sore in paraplegic patients results in excessive urethral pressure with the patient in the sitting position, thereby predisposing the membraneous or proximal bulbous urethra to problems related to ischemia. Urethrocutaneous fistula or urethral defect is one of those problems and if these complications are developed, the functional and anatomical reconstruction of urethra is essential in paraplegic patients. In these cases we used distal flaps for reconstruction of urethral lining and sore coverage. That is, the distal portion of flaps was prefabricated by tubing procedure for the urethral lining, and transferred to the urethral defect site. And then bulky pedicle tissues of flaps were used for dead space filling. In these conditions the tensor fascia lata or gracilis muscle flaps were very useful and external sore opening was covered by posterior thigh fasciocutaneous V-Y advancement flap. We report our experiences on two cases of recurred ischial pressure sore complicated with urethral defect, which was successfully reconstructed and healed.