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  • Title: [Dangers of ischiectomy in ulcers in the paraplegic patient. Review of 236 records].
    Author: Berlemont M, Keromest R.
    Journal: Rev Chir Orthop Reparatrice Appar Mot; 1987; 73(8):656-64. PubMed ID: 3444945.
    Abstract:
    Two hundred and thirty-six paraplegics were operated on for unilateral or bilateral ischial ulceration between 1956 and 1981. A study was made of the long-term results, of the development of recurrences or bilateral involvement in unilateral lesions, of secondary complications and of their treatment and consequences. A distinction was made between procedures involving removal of the ischium and those with preservation of bone. The results, with a follow-up of one to 28 years were less satisfactory after extensive bony resection. Recurrence reached 50 per cent and a contralateral ulcer developed in up to 50 per cent. In contrast, when the ischium was preserved, these figures were respectively 20 per cent and 10 per cent. Complications such as the appearance of other pressure sores, or of perineal or urethral lesions occurred in 50 per cent of cases in which both ischia were resected but did not reach 15 per cent if the ischia were preserved. The analysis of these complications, their etiology and their outcome, with eleven deaths and two disarticulated hips implies the need to treat these ulcerations without removing the ischium. Infection and osteomyelitis can be healed without sacrifice of bone with at most one or two procedures preceding a plastic procedure. Myocutaneous flaps can be used to fill the lesions and to cover the bone with the help of proximal mobilisation of the hamstring muscles.
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