Reconstructive surgery for treating pressure ulcers

Abstract

Background The management of pressure ulcers involves several interventions ranging from pressure-relieving measures such as repositioning, to treatments that can include reconstructive surgery. Such surgery may be considered for recalcitrant wounds when full thickness skin loss arises and deeper structures such as muscle fascia and even bone are exposed. The surgery commonly involves wound debridement followed by the addition of new tissue into the wound. Whilst reconstructive surgery is an accepted means of ulcer management, the benefits and harms of surgery compared with non-surgical treatments, or alternative surgical approaches are not clear. Objectives To assess the effects of reconstructive surgery for healing pressure ulcers (stage II or above), comparing surgery with no surgery or comparing alternative forms of surgery in any care setting. Search methods We searched the following electronic databases to identify reports of relevant randomised clinical trials (searched 26 September 2016): the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL. We also searched three clinical trials registers and reference lists of relevant systematic reviews, meta-analyses and health technology assessment reports. Selection criteria Published or unpublished randomised controlled trials that assessed reconstructive surgery in the treatment of pressure ulcers. Data collection and analysis Two review authors independently performed study selection. We planned that two review authors would also assess the risk of bias and extract study data. Main results We did not identify any studies that met the review eligibility criteria nor any registered studies investigating the role of reconstructive surgery in the management of pressure ulcers. Key results We found no randomised controlled trials investigating reconstructive surgery for pressure ulcers. Certainty of the evidence The benefits and harms of reconstructive surgery for the treatment of pressure ulcers are uncertain and more rigorous research in this area is needed, especially as this question has been prioritised by patients, carers and health professionals. This plain language summary is up to date as of September 2016.

Evaluation of Therapeutic Outcomes of Reconstruction of Pressure Ulcer Injuries by Flap Coatings in Patients Admitted to Taleghani Hospital in Kermanshah during 2015-2016

“…Surgery typically involves ulcer debridement, along with replacement of damaged tissue with a new tissue at the site of the ulcer. W reconstructive surgery is an acceptable method in ulcer management [15]. In this study, success rate of pressure ulcer reconstruction was increased by coating flaps after 3 months.…”

Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management

“…Supplementary Table S2 summarizes main characteristics, results, methodological comments, and level of evidence for 26 clinical studies. In addition, seven systematic documents (five systematic reviews, 16,[22][23][24][25] one report of technology assessment, 26 and one meta-analysis 27 ), two in vitro studies, 28,29 four narrative reviews, 13,[30][31][32] and two consensusbased articles 33,34 were summarized in structured format and made available to experts.…”

Application of gluteus maximus fasciocutaneous V-Y advancement flap combined with resection in sacrococcygeal pressure ulcers

“…Therefore, surgeons should take comprehensive considerations based on the principles of PU surgery and plastic surgery. [ 19 ] The most common method to solve the problem of wound recovery is flap prosthetics. [ 20 ] Various flaps (generally accompanying Z-plasty and W-plasty), such as myocutaneous, fasciocutaneous, and subcutaneous flaps, and even some peculiar flaps, such as island flaps, perforator flaps, V-Y flaps, and distally based flaps, are applied in plastic surgery.…”