Multivariate Predictors of Failure after Flap Coverage of Pressure Ulcers

Abstract

Confirmation of adequate nutritional status and strict preoperative management of blood glucose may improve operative success rates. The authors propose that operative management should be approached with trepidation, if at all, in young patients with recurrent ischial ulcers.

A retrospective study: Multivariate logistic regression analysis of the outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous, and perforator flaps

“…Absolutely bed rest after operation should be emphasized repeatedly to these patients. Our study confirmed the conclusion of several earlier studies, namely that there is no significant difference among different surgical approaches in terms of complication or recurrence rates (3,6,7). However, little is known about the correlation between our described possible risk factors and the complication/recurrence rates in specific reconstruction methods.…”

“…We considered gender, surgical method, age > 45 years at the time of surgery, wound location, defect size exceeding 50 cm 2 , pre-surgical albumin level less than or equal to 3.0g/dl, previous flap failure, paraplegia status, the existence of other concurrent ulcers, and medical history of diabetes as potential confounders in the analysis, according to previous studies (3,6,9). We performed the multivariable logistic regression model using forward elimination to control for each patient's specific effect on wound complication and recurrence rates while adjusting for confounding variables.…”

“…Nutritional status is one of the most important patient characteristic. In fact, the correlation between malnourished status and pressure sore development has been clearly documented (6,9).…”

“…The correlation between paraplegia and age at surgery ≤ 45 were significantly in our study (p< 0.001). The reason of significantly high complication rate in young traumatic paraplegics may be that they had poor compliance with long periods of bed rest after surgery, notwithstanding its overall importance to wound healing (6). Absolutely bed rest after operation should be emphasized repeatedly to these patients.…”

“…Stage 3 and 4 M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 pressure sores, however, additionally require repetitive debridement of necrotic tissue and further skin flap reconstruction. Despite advancements in medical care and surgical technique, pressure sore reconstruction remains a formidable challenge for plastic surgeons because patients who undergo such surgery are prone to high rates of complication and recurrence (3,6). Therefore, it is important to investigate proper therapeutic intervention for patients requiring ulcer reconstruction, especially those with postoperative failure associated factors.…”