Effectiveness of Flaps Controlling Inflammation for Severe Pressure Sores in Older Patients with Multiple Comorbidities

Abstract

Background: Older patients with pressure sores secondary to medical problems generally are not likely to become physically active again and are therefore rarely considered candidates for flap surgery. When surgeons decide whether to perform surgery in older individuals with multiple morbidities, they must weigh the risks of prolonged general anesthesia and the burdens of flap surgery against the benefits of the flap.Methods: This retrospective study included patients over 65 years of age who were treated at our clinic from May 2010 to August 2018 for grade III or IV pressure sores. They underwent either general wound care without flap coverage (debridement only) or complete flap coverage of the sore (debridement plus flap group). We compared changes in laboratory blood tests from pre-operation to post-operation.Results: A total of 63 patients were included, with 53 in the flap coverage group and 10 in the control group. Age, sex, and flap size were statistically similar between groups (P>0.05). The control group exhibited no significant laboratory changes after debridement. The flap coverage group exhibited statistically significant improvements in neutrophil percentage and C-reactive protein level postoperatively (P<0.05, paired t-test). Serum hemoglobin, albumin and electrolyte levels did not differ with statistical significance from pre-operation to post-operation in either group (P>0.05, Wilcoxon signed-rank test and paired t-test).Conclusion: As pressure sore coverage with flaps may have a positive effect on controlling inflammation, flap surgery could be a viable option for older patients with severe pressure sores.