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Negosanti L, Sanguinetti G, Musumeci G, Bettini F, Salucci P, Rucci P, Landi S, Sgarzani R. Outcomes of Pressure Sore Surgery in Patients with Spinal Cord Injury and Spasticity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5632. [PMID: 38435462 PMCID: PMC10906608 DOI: 10.1097/gox.0000000000005632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024]
Abstract
Background Spasticity is a serious complication of spinal cord injury/disease (SCI/D) that affects 60%-80% of patients with this condition. The presence of spasticity can have a significant impact on the outcomes of reconstructive surgical interventions, such as those on pressure sores (PSs). Moreover, in the conservative treatment of PSs, spasticity may prevent maintaining adequate postures to avoid skin friction or traction. The aim of this study is to describe the PS reconstruction outcomes in a cohort of patients with SCI/D affected by spasticity. Methods In this retrospective study of patients with SCI/D consecutively admitted to Montecatone Rehabilitation Institute between October 2013 and March 2022, 54 PSs were treated in 46 people with spasticity. Results Postsurgery complications occurred in 26 of 54 treated PS, of which seven were major. Eleven patients experienced more than one complication. The overall incidence of postsurgical complications was 48.1%, and the incidence of major complications was 13%. Median length of hospital stay was 3.8 versus 1.8 months. Compared with other reports in the literature of PS reconstruction in patients with SCI/D, we found higher rates of overall, minor, and major complications. Conclusions Spasticity proved to be an important condition to consider, and its treatment requires specialized physicians. The collaboration between plastic surgeons and spasticity specialists is crucial to define the best treatment to reduce postoperative complications.
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Affiliation(s)
- Luca Negosanti
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Giorgio Sanguinetti
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Gaia Musumeci
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Francesca Bettini
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Pamela Salucci
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Paola Rucci
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Siriana Landi
- From the Specialized Care Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Rossella Sgarzani
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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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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Cheng TW, Lin YN, Lee SS, Kuo YR. The niche of dermal graft to reconstruct a complex pressure injury wound in sacral region: A case report. Medicine (Baltimore) 2023; 102:e36617. [PMID: 38134078 PMCID: PMC10735093 DOI: 10.1097/md.0000000000036617] [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] [Received: 09/05/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE Pressure ulcers are a common health issue, particularly among elderly and bedridden patients who are vulnerable to pressure injuries in the sacral region. Currently, free flap and local flap surgeries are the gold standard procedures for the reconstruction of such injuries. However, the recurrence rate of flap surgery appears to be high. In this context, we presented a case involving a sacral pressure ulcer reconstructed with dermal grafting. PATIENT CONCERNS A 59-year-old male with a medical history of hepatitis C, brain hemorrhage, hydrocephalus, and multiple fractures presented with a sacral ulcer. Owing to the patient's history of recurrent pressure injuries and the challenges associated with postoperative wound care, the patient and his family were hesitant to proceed with flap surgery. DIAGNOSES The patient was diagnosed with a stage IV pressure ulcer measuring 4 cm × 4 cm in size in the sacral region, according to the National Pressure Ulcer Advisory Panel staging system. INTERVENTIONS Before surgery, the patient received standard wound care with dressing for 4 months, along with short-term oral antibiotics due to a positive wound culture for Pseudomonas aeruginosa. During the surgery, a dermal graft with a size of 35 cm2 and a thickness of 0.014 inches was harvested from the patient's left thigh. The graft was then secured to the wound bed. OUTCOMES Although the dermal graft failed with sloughing after 1 week, the wound bed showed improvement with granulation. After 1.5 months, the wound area had decreased to half of its original size, and the wound eventually healed after 3.5 months. LESSONS Dermal grafts have a niche in reconstructing pressure injury wounds in the sacral region, because of the relative ease of wound care and additional benefits even in cases where the graft fails.
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Affiliation(s)
- Te-Wei Cheng
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yun-Nan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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McCranie AS, Constantine RS, Lee N, Le ELH, Gehring M, Iorio ML. Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database. Wound Repair Regen 2023; 31:641-646. [PMID: 37583305 DOI: 10.1111/wrr.13110] [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: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023]
Abstract
In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.
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Affiliation(s)
- Alec S McCranie
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan S Constantine
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nayun Lee
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elliot L H Le
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Gehring
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew L Iorio
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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5
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Adamson SR, Whitty S, Flood S, Neoh D, Nunn A, Clegg B, Ng SKH. Surgical management of pressure ulcers in spinal cord injury patients. ANZ J Surg 2023; 93:1348-1354. [PMID: 37079802 DOI: 10.1111/ans.18391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Pressure ulcers (PU) are a common yet debilitating injury within the spinal cord injury (SCI) population. This retrospective data analysis is intended to identify the contributing factors, review the current management protocol, and risk of recurrence of PU in SCI patients at Victoria's state referral centre for traumatic spinal cord injuries. METHODS A retrospective audit of the medical records of SCI patients with pressure ulcers was conducted for the period of January 2016 to August 2021. Patients aged 18 years and older who presented for surgical management of their PU were included in the study. RESULTS Among the 93 patients who met the inclusion criteria, there were a total of 195 surgeries for 129 PU. Ninety-seven percent were classified as grade of 3 or 4 and 53% had osteomyelitis on presentation. 58% were either current smokers or ex-smokers, and 19% were diabetic. Debridement alone was the most common type of surgical management (58%), followed by flap reconstruction (25%). Those who underwent flap reconstruction were admitted for 71 days longer, on average. 41% of the surgeries were associated with a post-operative complication, with the most prominent being an infection at 26%. Of the 129 PU, 11% recurred at least 4 months post initial presentation. CONCLUSION There are a multitude of a factors that impact prevalence, surgical complications, and recurrence of PU. This study provides insight into these factors to review our current practices and optimize surgical outcomes in the management of PU in the SCI population.
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Affiliation(s)
- Sarah Rose Adamson
- Department of Plastic & Reconstructive Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Sarah Whitty
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Flood
- Department of Plastic & Reconstructive Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Derek Neoh
- Department of Plastic & Reconstructive Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Victoria, Australia
| | - Ben Clegg
- Victorian Spinal Cord Service, Austin Health, Melbourne, Victoria, Australia
| | - Sally Kiu-Huen Ng
- Department of Plastic & Reconstructive Surgery, Austin Health, Melbourne, Victoria, Australia
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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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7
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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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8
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Qazi M, Khattak AF, Barki MT. Pressure Ulcers in Admitted Patients at a Tertiary Care Hospital. Cureus 2022; 14:e24298. [PMID: 35607569 PMCID: PMC9123348 DOI: 10.7759/cureus.24298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pressure ulcers (PUs) occur when the skin covering a weight-bearing part of the body is compressed for a long time between bone, any other part of the body, bed, chair, or any other hard surface. This study aimed to determine the prevalence of pressure ulcers at a tertiary care hospital in all specialty departments including COVID-19. Methods A retrospective study was conducted at North West General Hospital and Research Center, Peshawar, Pakistan. After obtaining ethical approval, data were obtained from the hospital database from July 2020 to June 2021. The keywords "bed sore," "pressure sore," and "pressure ulcer" were used to search for relevant cases, and patient demographics, including age and gender, site of pressure ulcer, stage of pressure ulcer, whether the pressure ulcer was single or multiple, length of stay at the hospital, and specialty department, were collected. Results In total, 99 patients met the inclusion criteria, of which 65 (65.7%) were males, while 34 (34.3%) were females. The age of the patients ranged from 15 to 92 years, with a mean age of 59.93 years. Of the patients, 87 (87.9%) had acquired only a single pressure ulcer. Stage 2 pressure ulcers were the most documented, making up 43.1% of the total cases reported, while stage 4 cases were only 3.3%. The sites most frequently affected by pressure ulcers were the gluteal and sacral regions, accounting for 34.4% and 30.3%, respectively. The incidence of pressure ulcers was the highest in the COVID-19 ward, i.e., 25.3%, followed by the neurosurgery ward with a 20.2% incidence. Conclusion Pressure ulcers occur frequently in almost all the specialty departments of a healthcare setting, especially in COVID-19 and neurosurgery wards, and impose significant physical, psychological, and financial burdens. The prevention of pressure ulcers is the best approach to avert patients and their families from all the burdens associated with pressure ulcers.
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Affiliation(s)
- Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Muhammad T Barki
- Neurological Surgery, North West General Hospital and Research Center, Peshawar, PAK
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Harper AE, Terhorst L, Brienza D, Leland NE. Exploring the first pressure injury and characteristics of subsequent pressure injury accrual following spinal cord injury. J Spinal Cord Med 2021; 44:972-977. [PMID: 32233917 PMCID: PMC8725761 DOI: 10.1080/10790268.2020.1744871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context/Objective: Clinicians have guidance on prevention and treatment of pressure injuries, but little is known regarding characteristics of patients who develop additional pressure injuries. Thus, our objective was to explore the first pressure injury and characteristics of individuals who develop subsequent pressure injuries during acute care and inpatient rehabilitation following spinal cord injury.Design: Secondary analysis of longitudinal data from a cohort of adults following initial traumatic spinal cord injury.Setting: Urban acute care hospital and inpatient rehabilitation facilities.Participants: A convenience sample of adults (n = 38) who developed at least one pressure injury during acute care and inpatient rehabilitation.Interventions: Not applicable.Outcome Measures: The primary outcomes were number of additional pressure injuries and stage of care during which they occurred, prior to community discharge.Results: A covariate-adjusted model revealed that participants with ASIA D injury had a 67% decrease in the rate of additional pressure injury incidence compared to participants with ASIA A injury (Rate Ratio = .33, 95% CI [0.13, 0.88]). The severity of the first pressure injury had no significant association with subsequent pressure injury incidence (P = .10).Conclusion: These findings indicated that individuals with greater sensory and motor loss had an increased risk of developing additional pressure injuries compared to individuals with less impairment. These results are meaningful for stakeholders interested in understanding factors associated with developing subsequent pressure injuries during the index rehabilitation stay and provide a foundation for future research in this area.
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Affiliation(s)
- Alexandra E. Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Correspondence to: Alexandra E. Harper, MOT, OTR/L, Graduate Student Researcher, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Suite 350, Pittsburgh, PA15219, USA; Ph: 412-624-7345.
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Brienza
- Department of Rehabilitation Science & Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Gelis A, Morel J, Amara B, Mauri C, Rouays H, Verollet C, Almeras I, Frasson N, Dupeyron A, Laffont I, Daures JP, Herlin C. "Doctor, how long will it take?" Results from an historical cohort on surgical pressure ulcer healing delay and related factors in persons with spinal cord injury. J Tissue Viability 2021; 30:237-243. [PMID: 33579584 DOI: 10.1016/j.jtv.2021.02.001] [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: 04/14/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Flap surgery for deep pelvic pressure ulcers has already shown its effectiveness. Most studies relating to the postoperative period assessed complications rates and associated risk factors, but none focused on delayed wound healing. The objective of this study was to describe wound healing delay after primary flap surgery in patients with spinal cord injury (SCI) and to assess associated risk factors. METHODS This observational retrospective study based on medical charts included all persons with SCI operated for primary flap surgery for pelvic PU in the Hérault department of France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomics and care management factors were studied. The primary outcome was wound healing delay, defined as time from surgery to complete cutaneous closure. RESULTS 85 patients were included. Median healing time was 48 days (R: 20-406). Healing rate was 70% at 3 months and 90% at 4 months. After a multivariate analysis three factors were significantly associated with delayed wound healing: duration of hospitalization in the acute care unit (HR = 2.68; p = 0.004), local post-operative complication (HR = 10.75; p = 0.02), and post-operative sepsis (HR = 2.18; p = 0.02). CONCLUSION After primary skin flap surgery for PU in persons with SCI, delayed wound healing is related to local or general complications as well as care management organization. The risk of delayed wound healing justifies the implementation of a coordinated pre-operative management to prevent complications and a structured care network for an earlier transfer to a SCI rehabilitation center.
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Affiliation(s)
- Anthony Gelis
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France.
| | - Juliette Morel
- Institut de Rééducation, CHU des Alpes, Avenue de Kimberley, 38130, Echirolles, France
| | - Bouali Amara
- Service de Chirurgie Plastique, Clinique Clémentville, 25 Rue de Clementville, 34070, Montpellier, France
| | - Cécile Mauri
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Hélène Rouays
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Christine Verollet
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Isabelle Almeras
- Clinique Du Dr Ster, 9 Avenue Dr Jean Ster, 34240, Nîmes, France
| | - Nicolas Frasson
- Clinique Du Dr Ster, 9 Avenue Dr Jean Ster, 34240, Nîmes, France
| | - Arnaud Dupeyron
- Département de Médecine Physique et de Réadaptation, CHU Carémeau, 2 Rue Du Pr Debré, 30029, Nîmes, France
| | - Isabelle Laffont
- Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Jean-Pierre Daures
- Institut Universitaire de Recherche Clinique, 75 Rue Professeur Truc, 34090, Montpellier, France
| | - Christian Herlin
- Département de Chirurgie Plastique, CHU Lapeyronie, 371 Avenue Du Doyen Gaston Giraud, 34090, Montpellier, France
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