Résumé
Introduction: spinal cord injured patients in wheelchair will develop for more than three quarters of them an ischial pressure ulcer during their lifetime. After cover surgery, 25% of the treated patients will develop a pressure ulcer recurrence. In terms of prevention, many technical and technological advances exist. However, the added handicap and the economic cost of pressure ulcers in the spinal cord injured patient pushes us to develop effective methods of primary and secondary prevention. Following the preliminary experience of some surgical teams, we retrospectively evaluated the efficacy of lipofilling in primary and secondary prevention of the occurrence of an ischial pressure ulcer.Material and methods: we carried out the retrospective study of all the cases made at the CHU of Montpellier and Toulouse. The collection covers 48 patients with 59 cases and 81 fat grafting procedures. We studied the treated population, the technique used, the operative follow-up and finally the occurrence or recurrence of an ischial ulcer. Results: in a population with a mean age of 54.12 years, we performed lipofilling in 9 cases in primary prevention and in 50 cases in secondary prevention. With a mean follow-up of 23,56 months, 1 patient develop a pressure ulcer in primary prevention and with an average follow-up of 28,57 months, 9 patients develop a recurrence in secondary prevention (3/15 post secondary healing, 2/3 post skin graft, 2/2 post direct closing and 2/30 post flap). In secondary prevention, the protective effect of fat grafting seemed more interesting after a flap and after a secondary healing. It did not seem interesting after skin grafting or direct closing.Conclusion: lipofilling seems to be a notorious advancement in the preventive management of ischial pressure ulcers. Only randomized, controlled prospective studies will validate and standardize this procedure in the surgical arsenal of spinal cord injured patients.