The use of argon beam coagulation in pressure sore reconstruction

Purpose: : Pressure sores are a significant source of physical and financial burden for debilitated patients. When conservative measures fail, surgical reconstruction with myocutaneous flaps may be the last hope for cure and/or improved quality of life in these patients. Adequate haemostasis is an integral component of these reconstructive procedures, as bleeding and haematoma formation can lead to increased morbidity. This study was designed to investigate the use of argon beam coagulation in patients undergoing bony debridement and subsequent pressure sore reconstruction with myocutaneous flaps. Methods: : The clinical records of 34 patients undergoing pressure sore reconstruction with the use of argon beam coagulation from 2004 to 2006 at an academic institution were reviewed and outcomes were assessed. Results: : Reconstruction was performed by a single surgeon on 34 patients (31 men, three women; mean age 41 ± 15 years), with a total of 41 pressure sores. Thirteen (32.5%) patients had evidence of osteomyelitis preoperatively and five (12.5%) had previous coccygectomies secondary to infection. Twenty-six (65%) of the pressure sores were treated with hamstring V-Y musculocutaneous flaps, 10 (25%) with gluteal flaps, and four (10%) with tensor fascia lata flaps. Overall, suture line dehiscence occurred in six (15%) cases, flap failure and pressure sore recurrence occurred in six (15%) cases, an abscess developed in one (2.5%) case, and a sinus tract with a superficial wound developed in one (2.5%) case. There were no complications related to haemostasis, including excessive bleeding or haematoma formation. Conclusions: : Argon beam coagulation is an efficacious tool for achieving adequate haemostasis during pressure sore reconstruction, particularly when significant bony debridement is involved. The use of argon beam coagulation does not result in an increased complication or recurrence rate when compared with conventional electrocautery methods.