Sensate flap for bed sores: Between dream and reality: A cadaver dissection study

Abstract

Background: Pressure sores are still a serious problem for paraplegic patients. For these patients, debilitating pressure sores in the ischial region, which is the primary weight bearing area, present a difficult problem. While there are various wound coverage procedures available, the chance of recurrence exists because of insensate skin and enormous pressure. The recovery of sensibility is of great importance, especially over the ischial area.Methods :The aim of our study is to provide a method to cover ischial sores with a sensate flap. A dissection of five cadavers was undertaken to work out the feasibility of this sensate flap. The skin component of tensor fascia lata flap which is innervated by the lateral cutaneous nerve of the thigh was utilized to cover the ischial sore. The anterior cutaneous branches of intercostal nerves from T10-T12 were used as the donor nerves. The recipient nerve was the lateral cutaneous nerve of the thigh.Results:Our dissection revealed that this technique of sensory reinnervation is possible. The anatomy was found to be consistent in all dissections. The length of the anterior cutaneous branch of intercostal nerves permitted tension free approximation of the donor and recipient nerves in all cadaver dissections.Conclusions:Appropriate candidates for this sensory flap are patients who have spinal cord damage at the thoraco lumbar junction. Clinical application of this sensate flap will be attempted when a suitable candidate is available. The results need to be analyzed carefully to assess the degree of return of sensation. It also needs to be established whether the addition of sensory stimulation to the flap would contribute greatly to the long term flap viability.