Tratamiento de la úlcera crónica isquiática en el paciente pediátrico refractaria a medidas Convencionales / Treatment of chronic ischial ulcer in the pediatric patient refractory to conventional treatments

Antecedentes. La úlcera por presión es una patología emergente, dada la mayor supervivencia de los pacientes pediátricos en riesgo de padecerla (mielomeningocele, afectos de parálisis cerebral infantil, parapléjicos, prematuros con secuelas neurológicas, etc.), así como los largos tiempos de estancia de los pacientes críticos ingresados en unidades de cuidados intensivos. Objetivos. Proporcionar un tratamiento definitivo de la úlcera por presión refractaria a procedimientos de desbridamiento. Métodos. Se utilizó la técnica de colgajo muscular de bíceps crural asociado a colgajo fasciocutáneo en dos pacientes; la primera, de 16años, con tetraparesia secundaria a parálisis cerebral infantil y la segunda, de 18 años, con secuelas de mielomeningocele lumbosacro. Ambas presentaban úlceras isquiáticas refractarias al tratamiento habitual, de2 y 3 años de evolución, respectivamente. Resultados. El resultado fue óptimo en ambos casos, con curacióndefinitiva de la úlcera y no reaparición de la misma durante uno y dos (..) (AU)

Background. Pressure ulcers are an emerging disease, due to survival increase of pediatric patients at risk (myelomeningocele, infantilecerebral paralysis, paraplegic, prematures with neurological sequelae,etc.), including as well, long time staging patients at intensive care units. Objectives: Provide for long-term treatment to pressure ulcer refractory to debridement procedures. Methods: We used the biceps femoris muscular flap technique associated with fasciocutaneous flap in two patients, 16 year-olded, with tetraparesis secondary to cerebral palsy and, another 18 year-olded, with myelomeningocele sequelae. Both had sciatic ulcers refractory to treatment, 2 and 3 years evolutioned, respectively. Results: The outcome was excellent in both cases, with definitive healing of the ulcer and no recurrence during one and two month (..) (AU)

[Treatment of chronic ischial ulcer in the pediatric patient refractory to conventional treatments]. / Tratamiento de la úlcera crónica isquiática en el paciente pediátrico refractaria a medidas convencionales.

BACKGROUND: Pressure ulcers are an emerging disease, due to survival increase of pediatric patients at risk (myelomeningocele, infantile cerebral paralysis, paraplegic, prematures with neurological sequelae, etc.), including as well, long time staging patients at intensive care units. OBJECTIVES: Provide for long-term treatment to pressure ulcer refractory to debridement procedures. METHODS: We used the biceps femoris muscular flap technique associated with fasciocutaneous flap in two patients, 16 year-olded, with tetraparesis secondary to cerebral palsy and, another 18 year-olded, with myelomeningocele sequelae. Both had sciatic ulcers refractory to treatment, 2 and 3 years evolutioned, respectively. RESULTS: The outcome was excellent in both cases, with definitive healing of the ulcer and no recurrence during one and two month follow-up. CONCLUSIONS: This technique, used in adults, can be applied to pediatric patients if no possibility of wandering. Muscle acts as a cuff between bone and skin and provides coating to the zone suffering pressure as an hypervascularized and no-functioning for active movement structure, but feasible in terms of trophism.