We report the case of a 41-year-old female smoker with a history of congenital myeloomelingocele and secondary paraplegia and nephrostomy in childhood.
He had been operated three years before in our service for presenting a sacral ulcer, performing a glue flap.
Since then she had not presented any recurrence due to her good postural hygiene at home.
Six months before going to our service again, she suffered a fracture of the sinus resulting in a pelvi-pedic cast.
The impossibility of mobilization and postural changes that the patient usually performed at home caused the appearance of a large ulcer in the sacral region, reason why she was referred to our consultation for evaluation.
At that time, he presented a large ischiotronchanteric-sacral ulcer of about 20 x 25 cm, with a fistulous tract toward the iliac pala and that in some areas deepened to the bony plane with sacral exposure.
It was recommended to admit the patient to hospital that she rejected for personal reasons, coming back at 3 weeks, when the ulcer already measured 24 x 30 cm.
During admission and due to the large ulcer that presented, she was diagnosed with dementia.
The patient had a poor general condition, with significant laboratory abnormalities both in hematocrit and total protein levels, so parenteral nutrition had to be started to return to her general condition.
To close the large defect it presented was operated and a posteromedial thigh flap was performed, to describe the alternative of the hip to debridement and cover it later articulate flap.
The intervention lasted about 5 hours and was uneventful.
The donor area of the flap was closed directly in most cases, having to cover only the distal portion with a partial skin graft taken from the contralateral thigh.
During the postoperative period, the patient was discharged to the ICU two days later to control her metabolic condition and returned to the hospital.
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After 15 days, the flap was in good condition with adequate capillary refill.
Nevertheless, the patient's general condition began to deteriorate.
It began with progressive hepatorenal insufficiency that after an exhaustive diagnosis by the Internal Medicine Service was classified as secondary to biliopancreatic alterations derived from parenteral nutrition.
After evaluation by the Nephrology Department, dialysis treatment was initiated, which improved creatinine levels, although a severe hypoproteinemia was observed that did not manifest a remounting appearance.
At the fourth week after surgery, the patient developed high fever of unknown origin, associated with sepsis and multiple organ failure, which led to death.
