26 years old, male, paraplegic, with extensive sacral, ischial and trochanteric pressure sores.

Fig. 1: initial aspect before treatment.

Fig. 2: initial aspect before treatment.

Fig. 3: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery.

Fig. 4: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery.

Fig. 5: different stages of LIGASANO® white treatment in order to clean the wound an to prepare it for surgery.

Fig. 6: surgical procedure (Arnold and McGraw bilateral gluteus maximus musculocutaneous flaps).

Fig. 7: surgical procedure (Arnold and McGraw bilateral gluteus maximus musculocutaneous flaps).

Fig. 8: three days after surgery.

Fig. 9: one week after surgery.

Fig. 10: 10 days after surgery.

Fig. 11: one month after surgery.

Fig. 12: bilateral ischial pressure sores one year after the initial treatment.

Fig. 13: bilateral ischial pressure sores one year after the initial treatment.

Fig. 14: local treatment with LIGASANO® white.

Fig. 15: after two weeks the wounds are clean and prepared for surgery.

Fig.16: first step: direct closure and drainage.

Fig. 17: second step: two very large bilateral posterior thigh flaps (“Tulenko flaps”) have been raised to cover the ischial pressure sores.

Fig. 18: few days after surgery.