A retrospective comparison of perforator and rotation flaps for the closure of extensive Stage IV sacral pressure ulcers.

Wound coverage using a flap, most commonly a perforator or rotation flap, often is required for the closure of extensive sacral pressure ulcers. To assess the duration of wound healing and postsurgical complications following two types of surgical closure procedure, perforator and rotation flaps, a retrospective study was conducted among a convenience sample of 20 patients (10 men, 10 women) with Stage IV sacral pressure ulcers. All ulcers were repaired in 2011 and 2012 by the same surgical group and included nine perforator and 11 rotation flaps. Patient demographic and wound outcomes data were abstracted, and data were analyzed using Wilcoxon signed rank and chi-squared tests. No significant differences were noted in patient demographics between the two groups, although serum albumin level in the rotation flap group was significantly higher than in the perforator flap group (P = 0.01). The mean follow-up period was 18 (range 6-30) months. Mean time to healing was 34 ± 15.4 (range 10-58) days in patients with a perforator flap and 45.5 ± 24.0 (range 11-80) days in patients with a rotation flap (P = 0.03). Patients who underwent rotation flap surgery had a higher rate of postoperative complications and a significantly higher rate of postsurgical seroma (n = 9) compared to those who underwent perforator flap surgery (n= 2) (P = 0.05). The mean time to healing in both groups was 13.5 days in patients without and 48.5 days in patients who developed a seroma. (P <0.01). The results of this study show the proportion of patients who develop a seroma following surgical repair of a sacral pressure is lower following perforator than rotation flap surgery. Additional clinical studies are needed to confirm these findings.