Bilateral Thigh Flaps: A Case Report and Review of Literature.

Background: Pressure ulcer management is difficult for the patient, relatives, doctor, and nursing staff and requires enormous resources. Management of multiple pressure ulcers in the spinal cord injured patient is a near-impossible task, especially in resource-deprived environments. The paraplegic, with multiple pressure ulcers, will frequently be managed under palliative care in these settings. A case report of a young motivated paraplegic with multiple infected pressure ulcers managed using total thigh flaps, in a rural hospital in Kenya is made. The surgical procedure is detailed, and a review of literature made.
Case Report: A 16-years old school boy presented to AIC Kijabe Hospital in extremis because of severe sepsis from multiple infected pressure ulcers. He had sustained a spinal cord injury 4 years previously, after a fall from a tree. After initial resuscitation, including nutritional support, blood transfusion, urinary drainage and stool diversion; bilateral hip disarticulation, pressure ulcer excision and defect closure using bilateral total thigh flaps was performed. All the pressure ulcers were successfully covered. Rehabilitation enabled him to find a new level of independence and self care. He returned to school.
Conclusion: Bilateral hip disarticulation with bilateral thigh flap utilization for the coverage of multiple pressure ulcers is a useful, life-saving tool. This procedure enhanced the patients’ independence and self-esteem. It is however, a tool to be used only as a last option.