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Burgos-Gutiérrez C, Álvarez-Buylla-Álvarez P, Álvarez-Viejo M, Pérez-López S, Pérez-Basterrechea M, Bea-Muñoz M, Pérez-Arias Á, De-Vicente-Rodríguez JC. Treatment of pressure ulcers in patients with spinal cord injury: Conventional surgery vs. cellular therapy. J Spinal Cord Med 2024; 47:246-254. [PMID: 34982655 PMCID: PMC10885747 DOI: 10.1080/10790268.2021.2014234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Relapse and recurrence rates of pressure injuries (PIs) are very high in spinal cord injured patients. That is the reason why alternative therapies, such the stem cells derived from bone marrow, have been developed. OBJECTIVE To compare this new technique of infiltration-infusion of mononuclear cells from bone marrow with conventional surgery. DESIGN A retrospective study was carried out in patients with spinal cord injuries who had PIs, category III/IV, in the pelvic area, during a 14-year follow-up period. SETTING One group was treated with conventional surgery and, in the other group, mononuclear cells were infused. PARTICIPANTS One hundred and forty-nine patients were registered, 63 (42.3%) in the conventional surgery group and 86 (57.7%) in the mononuclear cell group. RESULTS A comparative study between these 2 groups was carried out. There were no significant differences in ulcer healing in the first 6 months, but 6 months and one-year post-treatment, they were found. At 6 months, no patient in the conventional surgery group showed dehiscence or fistulization of the wound and, one year after surgery, only 3.17% recurred in the conventional group. In addition, there was a statistically significant relationship between days of hospitalization and the type of bacterial contamination and the intervention group. CONCLUSION Bone marrow mononuclear cell infusion-infiltration is an alternative treatment for PIs and fistula during the first 6 months, instead of conventional surgery. However, in the medium-long term, conventional surgery is more effective.
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Affiliation(s)
| | | | - María Álvarez-Viejo
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Silvia Pérez-López
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marcos Pérez-Basterrechea
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Bea-Muñoz
- Servicio de Rehabilitación, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ángel Pérez-Arias
- Servicio de Cirugía Plástica, Hospital Universitario Central de Asturias, Oviedo, Spain
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Fähndrich C, Gemperli A, Baumberger M, Bechtiger M, Roth B, Schaefer DJ, Wettstein R, Scheel-Sailer A. Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review. J Spinal Cord Med 2023; 46:705-715. [PMID: 36129337 PMCID: PMC10446796 DOI: 10.1080/10790268.2022.2108645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT The treatment of pressure injury (PI) stage III and IV in people with spinal cord injury or spinal cord disorder (SCI/D) requires a multidisciplinary and surgical involvement. OBJECTIVES This scoping review aims to identify published relevant surgical multidisciplinary treatment approaches, describe the elements and evaluate the effectiveness of the approaches. METHODS We searched PubMed and Medline databases for studies about treatment approaches for people aged ≥18 years with chronic SCI/D and PI stage III or IV over ischium, trochanter or sacrum published between January 1990 and December 2021 in English or German language. Two independent reviewers screened the articles. One reviewer extracted information on study author(s), year of publication, study title, study design, country of origin, sample size as well as data on elements and effectiveness of the approaches. RESULTS 10 different approaches were described in two retrospective cohort studies, three case series, five discussion papers, one review and one guideline. All approaches included debridement, flap surgery, pressure relief and immobilization as well as infection control. Some approaches described elements such as risk screening (7/10), osteomyelitis treatment (8/10), nutritional therapy (8/10), physiotherapy, occupational therapy and psychology (6/10), spasticity control (7/10), and prevention and education (6/10). Only one study reported on the effectiveness of the approaches. CONCLUSION There are key elements for surgical multidisciplinary treatment approaches. However, due to differences in the content of some of these elements and missing elements in some approaches, comparability is difficult and the effectiveness of the complex approaches remains uncertain.
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Affiliation(s)
- Carina Fähndrich
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | | | - Marco Bechtiger
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bianca Roth
- Department of Internal Medicine, Infectious Diseases Service, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Sgarzani R, Maietti E, Tedeschi S, Trapani FF, Battilana M, Landi S, Kiekens C, Negosanti L. Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study. Spinal Cord 2023; 61:204-210. [PMID: 36564552 DOI: 10.1038/s41393-022-00869-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol. SETTING Tertiary Rehabilitation Hospital for SCI/D in Italy. METHODS Retrospective analysis of the medical records of adult individuals with SCI/D, who developed a PI after the first discharge from a Spinal Unit, underwent flap surgery for PI between July 2011 and January 2018. The statistical unit of analysis was the surgical intervention. Logistic regression analysis with robust standard errors was performed to assess risk factors of post-surgical complications. RESULTS 434 surgical intervention records were included, for a total of 378 patients. The treated PIs were ischiatic in 56.2% of the cases, sacral in 32.5%, trochanteric in 15.7%, and 5.8% were in other sites. In 239 cases (55.1%) a histological diagnosis of osteomyelitis was confirmed. Minor complications occurred in 13.6% of interventions, while major complications were 3.9%. Sacral PI (OR = 2.55, 95%CI: 1.50-4.35) and muscular/musculocutaneous flap (OR = 2.12, 95%CI: 1.05-4.28) were significant factors associated with risk of post-surgical complications. After a mean follow-up of 21 months (range 12-36), six people (1.4%) had a recurrence. Patients with a recurrence had at least one comorbidity compared to 57% of people without recurrences (p = 0.036). CONCLUSION Our results demonstrate that complication and recurrence rates can be minimized when an established interdisciplinary and rehabilitation protocol is integrated in the clinical management.
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Affiliation(s)
- Rossella Sgarzani
- DIMES (Dipartimento di medicina specialistica, diagnostica e sperimentale), Università di Bologna, Bologna, Italy.
| | - Elisa Maietti
- DIBINEM (Dipartimento di Scienze Biomediche e Neuromotorie), Università di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio F Trapani
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Fukuoka K, Suyama Y, Morita M, Ikuta K, Kanayama H, Umeda R, Kimura Y, Donaka N, Fujii K, Yagi S. Preventing recurrence after surgical repair of pressure injuries in patients with spinal cord injury: Effects of a presurgical and postsurgical wheelchair seating intervention by experts. J Tissue Viability 2022; 31:552-556. [PMID: 35504795 DOI: 10.1016/j.jtv.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pressure injuries in people with spinal cord injury or dysfunction (SCI/D) are known to have a high recurrence rate. As a countermeasure, we perform surgery after adjusting the wheelchair and cushion with the intervention of a seating expert. The effectiveness of seating interventions in postsurgical recurrence prevention was examined. MATERIALS AND METHODS In this retrospective analysis, the participants were 19 patients with SCI/D who underwent pressure injury surgical treatment in the gluteal region from 2005 to 2018. The patients with conventional rehabilitation were assigned to Group 1 (n = 8), and those with seating intervention by experts in addition to conventional rehabilitation were assigned to Group 2 (n = 11). The main outcome measure was the presence or absence of recurrence 3 years after the surgery. The recurrence rate was compared between the two groups. RESULTS The recurrence rates were 18% with seating intervention and 75% without; there was a significant difference (p = 0.025). The recurrence odds ratio was 13.5. CONCLUSION This study suggests that presurgical seating evaluation and assessment by experts, postsurgical rehabilitation based on presurgical evaluation and assessment, and routine follow-up and seating adjustment according to changes are efficacious for preventing postsurgical pressure injury recurrence in patients with SCI/D.
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Affiliation(s)
- Kohei Fukuoka
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan.
| | - Yoshiko Suyama
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Maki Morita
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Kento Ikuta
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Haruka Kanayama
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Ryunosuke Umeda
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Yuka Kimura
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Nobuki Donaka
- Department of Rehabilitation, Yowa Hospital, 3-5-1, Kamigoto, Yonago, 683-0841, Japan
| | - Kaori Fujii
- Department of Nursing, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
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Fagotti de Almeida CE, Cirino Dos Santos APB, Biaziolo CFB, Mateus de Vasconcelos ECL, Oliveira FV, Jorge JLG, Ferreira MC, Coltro PS, Junior JAF. The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region. J Wound Care 2022; 31:92-98. [PMID: 35077205 DOI: 10.12968/jowc.2022.31.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation-direct cell deformation, inflammatory oedema and ischaemic damage-which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery. METHOD Patients with deep PI in the pelvic region, who were operated on from 2011 to 2019, were retrospectively evaluated. The protocol of care included training in the prone position, followed by maintenance of the prone position for 4-6 weeks postoperatively. The reconstruction was performed with fasciocutaneous and myocutaneous local or regional flaps. RESULTS The study evaluated a total of 26 patients. The rate of recurrence of PIs was 15.4% (4/26) in the mean follow-up of 54 months. Regarding postoperative complications, four cases of partial dehiscence of the suture occurred. CONCLUSION This perioperative protocol of maintaining a prone position seems to be safe for the patient, and it can be used to prevent or reduce the recurrence of deep PIs on the pelvic region after reconstructive surgery.
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Affiliation(s)
| | | | | | | | | | - João Luís Gil Jorge
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Marcus Castro Ferreira
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Pedro Soler Coltro
- Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Su S, Ding X, Zou H, Lin Y, Huang J, Xiong D, Kuan J, Zhang Y, Xie R. Wound Management of Multi-Site Pressure Ulcer at Different Stages in Elderly Patients. Clin Cosmet Investig Dermatol 2021; 14:747-751. [PMID: 34234500 PMCID: PMC8254520 DOI: 10.2147/ccid.s316694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
Objective The present study aims to explore the individualized treatment options for multisite pressure ulcer (PU) at various stages in elderly patients with multiple medical conditions. Methods Stages 1 and 2 PU at 146 sites were treated with closed negative pressure suction combined with continuous micro-oxygen perfusion and the local application of foam dressings, silver ion dressings, and moist burn cream. Stages 3 and 4 PU in the sacrococcygeal region were treated with skin or myocutaneous flap transplantation. Results Stages 1 and 2 PU healed after treatment with closed negative pressure suction combined with continuous micro-oxygen perfusion and dressing changes. One case died during hospitalization due to an illness. Skin or myocutaneous flap repair was conducted in 34 cases of stage 3 or 4 PU in the sacrococcygeal area. Of these cases, 28 achieved primary healing, and 6 required two or three surgeries, 5 of which received micro-skin implantation. In addition, 10 small deep PU at other sites were repaired by direct excision and suturing or local flap repair. Seven cases were transferred to other departments or hospitals due to concomitant diseases or were discharged automatically without surgical treatment. Conclusion Home care for geriatric patients is difficult. PU often occur at multiple sites because of the duration of various pressures, and different sites may demonstrate different stages because of varying degrees of pressure. When actively treating stages 3 and 4 PU, the trauma management of stages 1 and 2 PU should not be neglected.
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Affiliation(s)
- Shunqing Su
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Xiumei Ding
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Huijuan Zou
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Yuechun Lin
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Jianmin Huang
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Disheng Xiong
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Jinan Kuan
- Department of Burn&Plast, Dalang Hospital of Dongguan, Dongguang, Guangdong, 523780, People's Republic of China
| | - Yanhong Zhang
- Department of Wound Repair, Hongmei Hospital of Dongguan, Dongguang, Guangdong, 523160, People's Republic of China
| | - Rurong Xie
- Department of Wound Repair, Hongmei Hospital of Dongguan, Dongguang, Guangdong, 523160, People's Republic of China
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Asanza JL, Matsuwaka ST, Keys K, Arrowood C, Doan MM, Burns SP. Comparing 4- and 6-week post-flap protocols in patients with spinal cord injury. J Spinal Cord Med 2021; 44:392-398. [PMID: 31859608 PMCID: PMC8081300 DOI: 10.1080/10790268.2019.1703501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: For patients with spinal cord injury (SCI) who undergo flap surgery to treat pressure injuries (PIs), the optimal duration of post-operative bedrest to promote healing and successful remobilization to sitting is unknown. At the study center, the minimum duration of post-operative bedrest was changed from 4 to 6 weeks. The purpose of this study is to compare outcomes of patients who underwent flap surgery using bedrest protocols of different duration.Design: This was a retrospective review of all flap procedures completed at VA Puget Sound Health Care System from 1997 to 2016 to treat PIs in patients with SCI. Surgeries were excluded if they were not a flap (i.e. primary skin closure or graft), involved a non-pelvic region, or were a same-hospitalization revision of a prior surgery. The primary outcome of this investigation was the number of days between surgery and the first time the patient mobilized to sitting out of bed for 2 h with an intact surgical incision.Methods: 190 patients received a total of 286 flap surgeries from 1994 to 2016. A chart review of each case was completed to determine the planned duration of bedrest (4- vs 6-weeks), first date of successful mobilization out of bed for 2 h, length of stay post-surgery, and occurrence of complications such as dehiscence or need for operative revisions.Results: Among 286 primary surgeries, 171 surgeries used the 4-week protocol and 115 used the 6-week protocol. When compared to the 4-week protocol, patients treated with the 6-week protocol were slightly older, more likely to have a diagnosis of diabetes, and less likely to be current smokers. Healing was never achieved after 4 surgeries in the 4-week group and 2 surgeries in the 6-week group. With the analysis restricted to a single surgery per subject who achieved healing (109 treated with 4-week protocol and 75 with 6-week protocol), there was a significant difference in days until 2-h sitting: median 54 days for the 4-week protocol compared to 60 days for the 6-week protocol (p = 0.041). Up to about 60 days post-operatively, the 4-week protocol produced a greater proportion remobilized to sitting, and thereafter the proportion of patients successfully remobilized did not differ between protocols.Conclusions: The 6-week protocol was not associated with improved remobilization outcomes (reduced rates of dehiscence or surgical revisions), and the 4-week protocol resulted in a significantly shorter time to remobilization to sitting for 2 h as well as a shorter length of stay. We did not identify any subgroup of patients that benefited from the longer protocol.
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Affiliation(s)
- Juan L. Asanza
- VA Puget Sound Health Care System, Seattle, Washington,USA
- University of Washington, Department of Rehabilitation Medicine, Seattle, Washington,USA
| | - Sean T. Matsuwaka
- University of Washington, Department of Rehabilitation Medicine, Seattle, Washington,USA
| | - Kari Keys
- Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington,USA
- University of Washington, Department of Plastic Surgery, Seattle, Washington,USA
| | - Cynthia Arrowood
- Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington,USA
| | - Meghan Meinerz Doan
- Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington,USA
| | - Stephen P. Burns
- University of Washington, Department of Rehabilitation Medicine, Seattle, Washington,USA
- Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington,USA
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Braafhart M, de Laat HEW, Wagner T, van de Burgt EWT, Hummelink S, Ulrich DJO. Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach? J Tissue Viability 2020; 29:319-323. [PMID: 32883591 DOI: 10.1016/j.jtv.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/27/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. OBJECTIVE The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. METHOD A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. RESULTS The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. CONCLUSIONS There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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Affiliation(s)
- Marieke Braafhart
- Skin Therapy, Hogeschool Utrecht, Universities of Applied Science, the Netherlands
| | - Henricus E W de Laat
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Till Wagner
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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9
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Distal partial gluteus maximus musculocutaneous V-Y flap: a simplified technique for reconstruction of ischial pressure sores. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01570-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Lindqvist EK, Sommar P, Stenius M, Lagergren JF. Complications after pressure ulcer surgery – a study of 118 operations in spinal cord injured patients. J Plast Surg Hand Surg 2020; 54:145-150. [DOI: 10.1080/2000656x.2020.1720700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ebba K. Lindqvist
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pehr Sommar
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine Stenius
- Rehab Station Stockholm/Spinaliskliniken, Research and Development Unit, Stockholm, Sweden
| | - Jakob F. Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Papp AA. Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction. Int Wound J 2019; 16:394-400. [PMID: 30548531 PMCID: PMC7948904 DOI: 10.1111/iwj.13045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 12/30/2022] Open
Abstract
Complications after pressure ulcer reconstruction are common. A complication rate of 21% to 58% and a 27% wound recurrence has been reported. The aim of this study was to decrease postoperative wound-healing complications with incisional negative pressure wound therapy (iNPWT) postoperatively. This was a prospective non-randomised trial with a historic control. Surgically treated pressure ulcer patients receiving iNPWT were included in the prospective part of the study (Treatment group) and compared with the historic patient cohort of all consecutive surgically treated pressure ulcer patients during a 2-year period preceding the initiation of iNPWT (Control). There were 24 patients in the Control and 37 in the Treatment groups. The demographics between groups were similar. There was a 74% reduction in in-hospital complications in the Treatment group (10.8% vs 41.7%, P = 0.0051), 27% reduction in the length of stay (24.8 vs 33.8 days, P = 0.0103), and a 78% reduction in the number of open wounds at 3 months (5.4 vs 25%, P = -0.0481). Recurrent wounds and history of previous surgery were risk factors for complications. Incisional negative pressure wound therapy shortens hospital stay, number of postoperative complications, and the number of recurrent open wounds at 3 months after reconstructive pressure ulcer surgery, resulting in significant cost savings.
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Affiliation(s)
- Anthony A. Papp
- Vancouver General HospitalVancouverBritish ColumbiaCanada
- Division of Plastic SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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