الفهرس 
Introduction
Pathophysiology of pressure soresOnly 14 pages are availabe for public view
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Abstract
Dissertation Abstract : T The best treatment of pressure sores is prevention. Once they occur the key component in the management of any pressure sore is the relief of pressure and avoidance of other physical forces that contribute to the persistence and progression of the lesion. Adherence to wound management and dressing guidelines optimize wound healing outcomes and wound closure. Patient education, skin care, and rehabilitation are essential components in pressure sore management. Optimization of nutrition, wound bacterial balance, spasticity, and comorbidities are required for all patients suffering from a pressure sore. When we take the decision for the surgical reconstruction for coverage of pressure sore, it is important to remember that pressure sores can recur. Proper flap selection will allow successful coverage while preserving the options of neighboring flaps for future use. Postoperative management is as important as the operative procedure itself. Positioning, control of spasticity, optimization of nutrition, bowel and bladder management, wound care, treatment of comorbidities and rehabilitation are important factors for a successful outcome in pressure sores reconstruction.
We made our study over 20 patients with an average age of (16- 54 years). 15 males and 5–held females were included within the study. All cases had grade 3, grade 4 sacral pressure sore .we used hand Doppler for detection of perforators preoperatively. Then they made the choice for flap pattern either rotational, propeller or v-y advancement. All our flaps were harvested subfascial plane, medially rotated to cover the bed sore after good hemostasis. We obtained satisfactory results Among the 20 flaps harvested; 19 flaps survived well (95% survival rate); only one was lost due to sever congestion of the main perforator. Only 3cases showed
congestion postoperatively, 2 cases showed wound dehiscence due to infection.one case showed hematoma.
Our results are similar to other literature results to a great extent. All confirming the efficacy and rich vascularity this flap has. SGAP flap is recommended by us as a golden tool restoring both function and aesthetic appearance of buttock. In conclusion, sacral sore management is difficult, and flaps must be chosen carefully. The SGAP flap provides a large, bulky and safe fasciocutaneous flap to cover sacral pressure sores. The flap also minimizes blood loss and donor-site morbidity and preserves muscle function. As with other perforator flaps, pedicle dissection requires a meticulous dissection technique to prevent damage to the perforator vessels. We showed that a deep pedicle dissection is unnecessary when surgery involves an accurate indicating perforator, adequate flap size design and accurate choice of either the