Protocol Management of Late-Stage Pressure Ulcers

Larson, David L.; Hudak, Kristen A; Waring, William P.; Orr, Merle R.; Simonelic, Kevin

doi:10.1097/prs.0b013e3182442197

Cited by 57 publications

(32 citation statements)

References 18 publications

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“…The most frequently involved spinal segment is the lumbar spine (58%), followed by the thoracic spine (30%), and the cervical spine (11%) [6]. Hematogenous sacral infection is rare [11][12][13]. In most cases, sacral osteomyelitis results from pressure ulcers, trauma, surgery, or through contiguous spread from a pelvic infection [11,12].…”

Section: Epidemiologymentioning

confidence: 99%

“…Hematogenous sacral infection is rare [11][12][13]. In most cases, sacral osteomyelitis results from pressure ulcers, trauma, surgery, or through contiguous spread from a pelvic infection [11,12]. The spinal infection can extend posteriorly and result in epidural or subdural abscess, or even meningitis, while lateral spread can result in psoas, retroperitoneal, subphrenic, paravertebral, retropharyngeal, and mediastinal abscesses.…”

Section: Epidemiologymentioning

confidence: 99%

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Spinal Infections: An Update

et al. 2020

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Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. The most common route for spinal infection is through hematogenous spread of the microorganism from a distant infected area. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required. In either case, close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Spinal Infections: An Update

et al. 2020

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“…Instead, bony resection is determined by the amount of unhealthy bone identified during the surgical/operative examination, as well as the degree of bony prominence that would lead to persistent focal pressure if not removed. In 2012, Larson et al 9 published one of the largest series to date on late-stage pressure ulcers using a retrospective design to determine the effect of using a standardized protocol on postoperative outcomes in 101 patients comprising 179 pressure ulcers. The protocol used in the Larson study is similar to this study, with the exceptions that pressure ulcers in close proximity to the anus of the patients in this study were reconstructed only after colostomy, we did not perform primary closure (compared to 48%), and all of our patients were stage IV (compared to 87%).…”

Section: Discussionmentioning

confidence: 99%

Seeing is Believing? Preoperative Magnetic Resonance Imaging for Pressure Ulcers: Implications for Surgical Management

McCarthy

Hartmann

Bentz

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Pressure ulcers represent a particularly difficult disease process and remain a financially important entity. The underlying bone in advanced ulcers may harbor osteomyelitis. Radiologic diagnosis of osteomyelitis is confounded by chronic pressure and shear. We sought to determine the test characteristics of preoperative magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis compared to intraoperative bone culture.Methods:A retrospective review of patients undergoing flap reconstruction who had preoperative MRI and intraoperative bone cultures between 1995 and 2015 was included. Recorded variables included age, sex, level of spinal cord injury and duration, preoperative MRI interpretation, microbiologic bone culture, smoking history, comorbidities, colostomy or urostomy, healing time, complications, length of stay, and discharge facility.Results:A total of 152 patients (175 flaps) were reconstructed, of which 41 patients (73 flaps) met inclusion criteria. Most patients were male (82.2%) with an average age of 50.4 years. Overall complication rate was 32.4% (n = 23) of which 34.7% (n = 8) were major. Positive and negative predictive MRI values were 84.6% and 16.7%, respectively. There were no significant differences in healing time or complication rate in those with or without osteomyelitis. Intraoperative growth was associated with decreased postoperative complications (hazard ratio = 0.361; P = 0.037).Conclusion:Test properties of MRI for diagnosis of osteomyelitis in patients with chronic pressure ulcers have limited ability to diagnose osteomyelitis and do not aid in surgical management, but do increase health-care expense. The diagnosis of osteomyelitis by intraoperative bone cultures does not predict inferior outcomes and paradoxically may be associated with fewer postoperative complications.

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“…2 Depending on the clinical setting, the occurrence of pressure ulcers varies widely, ranging from 0.4% to 66%, with higher incidence in quadriplegia and femoral neck fractures. 3 The treatment of pressure ulcers varies depending on ulcer depth, degree of undermining, concomitant infections, and associated complications. 7 Stage 1 and 2 ulcers are generally managed with a conservative approach such as pressure off-loading, wound care, and improved nutritional status of the patient.…”

Section: Introductionmentioning

confidence: 99%

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Gargano

Edstrom

Szymanski³

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Surgical treatment of pressure ulcers is challenging for high recurrence rates. Deepithelialized flaps have been used previously with the aim to eliminate shearing forces and the cone of pressure (COP) effect. The goal of this study is to adopt a standardized protocol and evaluate if 2 different flap techniques affect outcomes.Methods:The novel COP flap is illustrated. Twenty patients were prospectively treated with flap coverage over a 36-month period. According to the flap type, patients were assigned to 2 groups: group 1 with 11 patients treated with the COP flap and group 2 with 9 patients treated with conventional flap without anchoring technique. We adopted a standardized protocol of debridement, tissue cultures, and negative-pressure wound therapy. Rotation fasciocutaneous flaps were used for both groups and mean follow-up was 19 months. The COP flap is a large deepithelialized rotation flap inset with transcutaneous nonabsorbable bolster sutures. The 2 groups were comparable for demographics and ulcer location and size (P < 0.05). Five patients showed positive cultures and were treated with antibiotics and negative-pressure therapy before surgery.Results:Recurrence rates were 12% in the COP flap group and 60% in the conventional flap coverage group (P < 0.001). Results were compared at 16-month follow-up.Conclusions:The COP flap significantly reduces recurrences and eliminates shearing forces, suture ripping, and tension on superficial soft-tissue layers. The technique can be applied to both ischial and sacral pressure sores. The flap provides padding over bony prominence without jeopardizing flap vascularity.

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Protocol Management of Late-Stage Pressure Ulcers

Abstract: Therapeutic, IV.

Cited by 57 publications

References 18 publications

Spinal Infections: An Update

Spinal Infections: An Update

Seeing is Believing? Preoperative Magnetic Resonance Imaging for Pressure Ulcers: Implications for Surgical Management

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

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