Muscle coverage of pressure points--the role of myocutaneous flaps.

Although myocutaneous flaps have evolved into a primary method for managing pressure sores, their value in reducing the recurrence rate by padding the pressure point is open to question. The use of muscle to cover a pressure point violates the normal soft-tissue coverage of a bony prominence and introduces a tissue that is exquisitely sensitive to ischemia. Clinical follow-up of patients who have had myocutaneous flaps for closure of pressure sores demonstrates almost total muscle atrophy. Although skin coverage is stable, the muscle bulk of a myocutaneous flap is not retained beyond one to two years. The long-term value of myocutaneous flaps in reducing the recurrence rate of pressure sores requires careful follow-up in major series of cases.