Introduction : Despite prevention, pressure sores remain frequent in paraplegic patients. Although locoregional flaps usually cover the defect, some cases remain difficult such as reccurences or very large sores. When a local flap can not be applied successfully, other methods can be considered in order to avoid major complications or to leave the patient untreated. Free flap coverage can applied for these major defects because skin grafting or VAC therapy will be unsatisfactory.

Material&Methods: Between 1997 and 2001, 90 patients were operated for pressure sores in our department. Sacral sores were more frequent than ischiatic or trochanteric ones. In 6 patients, locoregional solutions were unavailable. These patients presented with pressure sores located in the ischiatic area (1), trochanteric area (1) and sacral, lombosacral or sacro-ischiatic area (4). The mean age was 50 years. All patients were paraplegic or had a stroke history. Parascapular, latissimus dorsi or free fillet flaps were used. Microvascular anastomosis was performed to the gluteal vessels for sacral sores, to the femoral vessels for ischiatic sores and to the transposed epigastric vessels for trochanteric sores.

Results: The microsurgical success rate was 100%, without any anastomosis revision. All flaps healed sponteanousely, except for one. A non-union of the scrotal suture of the fillet flap had to be reoperated twice before adequate healing. The follow-up was ranged between 16 and 62 months which was free of recurrences.

Conclusion: In these difficult situations, free flap coverage remains the only acceptable option. Moreover, other methods do not provide a stable and satisfactory coverage. Although these solutions can be considered as major surgery, mortality and morbidity was very low. With an adequate flap and recipient vessels selection this solution can be applied with a maximal security.