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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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Lu Y, Wu HL, Luo ZJ. Long-term debridement effect of denervated large sacrococcygeal pressure injury: A case report. Medicine (Baltimore) 2024; 103:e37012. [PMID: 38277574 PMCID: PMC10817163 DOI: 10.1097/md.0000000000037012] [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: 10/23/2023] [Accepted: 12/29/2023] [Indexed: 01/28/2024] Open
Abstract
RATIONALE Complicated pressure injury in paraplegic patients is common and difficult to manage. Previous case studies have documented short-term management; however, little is known regarding suitable approaches to long-term clearing of extensive pressure injury in the sacrococcygeal area under denervation. PATIENT CONCERNS A 53-year-old man was bedridden for 1.5 years owing to cervical vertebral fracture-dislocation (C5-C6), resulting in extensive sacrococcygeal pressure injury. DIAGNOSES On admission, he presented with the injury complicated by infection (stage IV necrosis), and his vital signs were unstable. INTERVENTIONS The infection was treated with a range of antibiotics, including clindamycin phosphate, metronidazole, cefoperazone sodium, and sulbactam sodium. Debridement of the pressure injury was performed, helping remove the necrotic tissue and stimulate tissue regeneration. OUTCOMES The patient was discharged after 88 days of hospitalization. The extent of the pressure injury at discharge was reduced compared with that at admission. At 4-month follow-up, the injury was nearly healed, with no signs of any further complications. LESSONS This case study suggests that wound debridement is a cost-effective and clinically efficacious approach to long-term complicated pressure injury management.
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Affiliation(s)
- Yan Lu
- Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Hai-Long Wu
- Department of Orthopedics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Zong-Jian Luo
- Department of Orthopedics, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin Province, China
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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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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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Jiao X, Cui C, Ng SKH, Jiang Z, Tu C, Zhou J, Lu X, Ouyang X, Luo T, Li K, Zhang Y. The modified bilobed flap for reconstructing sacral decubitus ulcers. BURNS & TRAUMA 2020; 8:tkaa012. [PMID: 33335930 PMCID: PMC7733162 DOI: 10.1093/burnst/tkaa012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/12/2019] [Indexed: 11/12/2022]
Abstract
Background Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer. Case presentation We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019. A description of our management, operative protocol, outcome and complications is outlined. Seven paraplegic patients (6 male, 1 female; average age 53.1 years) with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery. The average size of the pressure ulcers was 7 × 5 cm (range 6.2 × 4.5 cm to 11 × 10 cm). All 7 flaps survived. The patients were followed up for 12 months without significant complications, such as flap necrosis or recurrence. Conclusions The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap. The superior cluneal nerve can be included in the design. The technique is simple and reliable. It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.
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Affiliation(s)
- Xiangong Jiao
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Chunxiao Cui
- ENT Institute, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200011, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200011, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, 83 Fenyang Road, Shanghai 200011, China
| | - Sally Kiu-Huen Ng
- Department of Plastic Surgery, Austin Hospital, 145 Studley Road, Melbourne 3084, Australia
| | - Zhangjia Jiang
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Chihui Tu
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Jiemin Zhou
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Xiandong Lu
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Xianwen Ouyang
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Tong Luo
- Plastic, Reconstructive and Burn Centre, Liuyang People's Hospital, 49 Renmin Middle Road, Liuyang 410300, Hunan, China
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China
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Hödl M, Voithofer C. [Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients]. Pflege 2019; 32:181-187. [PMID: 31084289 DOI: 10.1024/1012-5302/a000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pressure ulcer risk assessment and preventive measures in mobile / chairfast / bedfast hospital patients Abstract. Background: Internationally, it is recommended to use the clinical view with a validated instrument for pressure ulcer risk assessment to determine subsequent measures. We could not identify any study investigating risk assessment and subsequent measures for mobile / chairfast / bedfast patients. Aim of the study: To identify the degree of agreement between the Bradenscale and clinical view regarding pressure ulcer risk in mobile / chairfast / bedfast patients and subsequent preventive measures. Method: Data from 5274 hospital patients from the "Nursing quality measurement 2015", a cross-sectional multicenter study, were collected. Results: Out of all mobile, chairfast or bedfast patients assessed as at risk of pressure ulcer with the Bradenscale, 22.3 % (mobile), 61.7 % (chairfast) and 86.1 % (bedfast) were also assessed as at risk by clinical view. More than 3 / 4 of the chairfast patients that were not at risk according to clinical view received preventive measures. Conclusion: The consequences over time for patients that received no measures due to discrepancies in the risk assessments should be focused. Furthermore the evaluation of measures in patients without a risk of pressure ulcer is of critical importance. The aspect of patient mobility deserves special attention due to the low agreement of the risk assessments in chairfast and mobile patients.
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Affiliation(s)
- Manuela Hödl
- 1 Institut für Pflegewissenschaft, Medizinische Universität Graz
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Singh R, Wadhwani J, Rohilla RK, Kaur K. Proximal femoral resection and Tensor Fascia Lata flap for recalcitrant trochanteric pressure ulcers. Spinal Cord Ser Cases 2019; 5:15. [PMID: 30729039 PMCID: PMC6363780 DOI: 10.1038/s41394-019-0157-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Trochanteric pressure ulcers (PrUs) are difficult to treat and are often complicated by infection spreading to the hip joint. We review three cases from India where proximal femoral resection and pedicled Tensor Fascia Lata (TFL) flapping was used in the management of infected deep trochanteric ulcers communicating to the hip joint. Case presentation Three patients had a total of four trochanteric PrUs communicating to the hip joint. Proximal femoral resection along with radical debridement of the pressure ulcer (PrU) was the first step in our surgical protocol. Serial debridements were performed to make the resulting cavity healthier and ready for the subsequent flap surgery. TFL flapping was done to cover the raw area of the PrU and the donor site was closed either primarily or with a split skin graft. All patients were males with AIS A spinal cord injury (SCI) and stage 4 PrUs in the trochanteric region. One patient had bilateral trochanteric ulcers. There was complete healing of all PrUs with improvement in wheelchair mobility, and general health. Discussion PrUs are a common complication of patients with SCI and are often considered one of the most neglected issues of health care delivery in India. Proximal femoral resection with pedicled TFL muscle flap is a versatile and reliable procedure for the coverage of recalcitrant trochanteric PrU with hip joint involvement. Minimal donor site morbidity occurs.
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Affiliation(s)
- Roop Singh
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Jitendra Wadhwani
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Rajesh Kumar Rohilla
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Kiranpreet Kaur
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
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Cai LZ, Chang J, Weiser TG, Forrester JD. Surgical Site Infections after Tissue Flaps Performed in Low- and Middle-Human Development Index Countries: A Systematic Review. Surg Infect (Larchmt) 2017; 18:765-773. [PMID: 28915094 DOI: 10.1089/sur.2017.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) affect the safety of surgical care and are particularly problematic and prevalent in low and middle Human Development Index Countries (LMHDICs). METHODS We performed a systematic review of the existing literature on SSIs after tissue flap procedures in LMHDICs through the PubMed, Ovid, and Web of Science databases. Of the 405 abstracts identified, 79 were selected for full text review, and 30 studies met inclusion criteria for analysis. RESULTS In the pooled analysis, the SSI rate was 5.8 infections per 100 flap procedures (95% confidence interval [CI] 2%-10%, range: 0-40%). The most common indication for tissue flap was pilonidal sinus repair, which had a pooled SSI rate of 5.6 infections per 100 flap procedures (95% CI 2%-10%, range: 0-15%). No fatalities from an infection were noted. The reporting of infection epidemiology, prevention, and treatment was poor, with few studies reporting antibiotic agent use (37%), responsible pathogens (13%), infection comorbidities (13%), or time to infection (7%); none reported cost. CONCLUSIONS Our review highlights the need for more work to develop standardized hospital-based reporting for surgical outcomes and complications, as well as future studies by large, multi-national groups to establish baseline incidence rates for SSIs and best practice guidelines to monitor SSI rates.
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Affiliation(s)
- Lawrence Z Cai
- 1 Stanford University School of Medicine , Stanford, California
| | - James Chang
- 2 Division of Plastic and Reconstructive Surgery, Stanford University Medical Center , Stanford, California
| | - Thomas G Weiser
- 3 Department of Surgery, Stanford University Medical Center , Stanford, California
| | - Joseph D Forrester
- 3 Department of Surgery, Stanford University Medical Center , Stanford, California
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Management of the Pressure Injury Patient with Osteomyelitis: An Algorithm. J Am Coll Surg 2017; 225:817-822. [PMID: 28882682 DOI: 10.1016/j.jamcollsurg.2017.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/12/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
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Biglari B, Büchler A, Reitzel T, Swing T, Gerner HJ, Ferbert T, Moghaddam A. A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients. Spinal Cord 2013; 52:80-3. [PMID: 24216618 DOI: 10.1038/sc.2013.130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective study reporting specific complications of certain skin flaps for treating pressure ulcers. OBJECTIVES To describe the rate and type of complications after pressure ulcer surgery in patients with spinal cord injury. SETTING Germany, Rheinland Pfalz. METHODS We collected data from 352 patients treated with 421 skin flaps to determine the rate and type of complications of each skin flap used. RESULTS In this study, we analyzed the results of 421 skin flaps in 352 patients with a total of 657 pressure ulcers from January 2006 to December 2010. Our patients had ischial, pelvic, sacral, trochanteric and lower extremity ulcers. Ischial ulcers were most common, followed by sacral and trochanteric ulcers. There were 87 complications in 421 flaps, which was an overall rate of 21%. Suture line dehiscence was the most common complication with 27 cases (31%), followed by 22 cases of infection (25.2%), 17 cases of hematoma (19.5%), 12 cases of partial necrosis (13.7%) and 9 cases of total flap necrosis (10.3%). CONCLUSION Pressure ulcers in spinal cord-injured patients are very common and difficult and expensive to treat. The high rate of complications and the associated costs suggest the importance of evaluating the efficacy of treatment options. Conservative procedures have been standardized, but there still has been limited success in establishing guidelines on how to manage complications arising from flap surgery. Our extensive documentation of flap plastics will be useful managing complications after the surgical treatment of pressure ulcers in spinal cord-injured patients.
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Affiliation(s)
- B Biglari
- Department of Paraplegiology, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - A Büchler
- Department of Orthopaedics, Trauma and Paraplegiologie, University Hospital Heidelberg, Heidelberg
| | - T Reitzel
- Department of Paraplegiology, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - T Swing
- Department of Orthopaedics, Trauma and Paraplegiologie, University Hospital Heidelberg, Heidelberg
| | - H J Gerner
- Department of Orthopaedics, Trauma and Paraplegiologie, University Hospital Heidelberg, Heidelberg
| | - T Ferbert
- Department of Orthopaedics, Trauma and Paraplegiologie, University Hospital Heidelberg, Heidelberg
| | - A Moghaddam
- Department of Orthopaedics, Trauma and Paraplegiologie, University Hospital Heidelberg, Heidelberg
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