Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction

Abstract

Objective: to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. Methods: retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. Results: in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. Conclusion: the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.

Knowledge on therapies for pressure ulcer: an integrative review

“…Um estudo descreveu a eficácia de um protocolo de atendimento perioperatório gerenciado pela equipe da cirurgia plástica para indivíduos com lesões por pressão, objetivando a internação curta para fechamento das lesões em apenas um momento cirúrgico. Destaca-se que o tratamento escolhido para o fechamento e correção foi o cirúrgico (8) . A modalidade de intervenção cirúrgica é recomendada para indivíduos com lesão por pressão em estágio 3 ou 4 que não cicatrize com tratamentos adequados ou em indivíduos que necessitem de um fechamento mais rápido da úlcera (2) .…”

“…O método de intervenção selecionado no referido estudo foi o desbridamento com bursectomia ampla e raspagem até o osso clinicamente viável, com imediata reconstrução, utilizando-se retalho locorregional fasciocutâneo. O emprego de retalhos fasciocutâneos se tornou rotina no serviço, posto que concedem uma adequada cobertura, proporcionando irrigação completa da ferida, com um bom preenchimento, além de proporcionar melhor controle de infecções (8) .…”

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“…Shearing forces are indirect factors that trigger pressure sores, and they occur when one is in an inclined position or surface [5]. It's caused by two entities move in separate directions like the tailbone moving down when one slides on an elevated bed [8]. Moisture, such as sweat, causes maceration and breakdown of tissues hence triggering or complicating pressure sores [28].…”

Double membrane based on lidocaine-coated polymyxin-alginate nanoparticles for wound healing: In vitro characterization and in vivo tissue repair

“…Ideal treatment approaches should include the stimulation of wound granulation, decrease of oedema, fluid and debris, and also the reduction of local bacterial contamination and pain (Andersen, 2019). The loss of skin integrity results in an imbalance of tissue homeostasis, as the complex, multifactorial, and continuous tissue repair process involves specific cellular mechanism and extracellular elements, such as cytokines and growth factors (Milcheski et al, 2017).…”