Risk factors for recurrence of pressure ulcers after defect reconstruction

Abstract

Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting-notably in the case of recurrences-additional strain on the constantly reduced resources in public healthcare. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center. In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence. The hospital patient database search included all patients with a diagnosis of pressure ulcers of the torso and lower extremity. One hundred sixty-three patients were diagnosed with pressure ulcers and 55 patients with 63 pressure ulcers met our inclusion criteria. The 17 recurrences (27%) had an average follow-up of 728 days. Most presented with lesions of the ischial tuberosity (n=24). Recurrence was statistically associated with defect size (p = 0.013, Cox regression analysis), and serum albumin levels (p = 0.045, Spearman correlation), but no association was found for body mass index, bacterial profile, comorbidities, localization, previous surgery, or time-to-admission for reconstruction (all p > 0.05). Supported by the recent literature we identified factors like defect size to be associated with pressure ulcer recurrence, but not with time-to admission for reconstruction or number of previous debridements. Whether laboratory values like serum albumin levels were the cause, the result or associated with pressure ulcer recurrence warrants further investigation.

Diverting Colostomy is an Effective Procedure for Ulcerative Chronic Radiation Proctitis Patients After Pelvic Malignancy Radiation

“…ALB has commonly been used as a nutritional assessment indicator. It was reported that ALB was a simple biomarker of wound healing in patients suffering from ulcers [34][35][36]. As consistent with previous researches, our study also indicated that a higher level of ALB was facilitated to ulcer healing.…”

Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

“…Most of the wounds in this study were over the ischial tuberosities, which is consistent with previously published literature . This relates to the fact that most paralysed patients spend much of their day sitting in their manual or power wheelchairs, and the seating systems are unfortunately not always optimised.…”

“…Most of the wounds in this study were over the ischial tuberosities, which is consistent with previously published literature. 4,[7][8][9][10] This relates to the fact that most paralysed patients spend much of their day sitting in their manual or power wheelchairs, and the seating systems are unfortunately not always optimised. Often, relating to their SCI and muscle wasting, there also is a lack of good-quality soft tissue coverage over the bony prominences in this area.…”

“…A 27% wound recurrence has been reported after flap reconstruction, and the recurrence was related to original wound defect size. 4 Overall complications of 21% to 58.7% [5][6][7][8] and recurrences of 16% after a mean follow-up of 55 months have been noted, with more recurrences over the ischial tuberosities. 6 Previous reconstruction has been shown to be a risk factor for postoperative dehiscence in ischial tuberosity pressure ulcers as well, 9,10 and wound dehiscence in general is the most common complication.…”

“…Complications are common, including wound dehiscence, surgical site infections (SSI), haematomas, seromas, partial or complete flap necrosis, and wound recurrences. A 27% wound recurrence has been reported after flap reconstruction, and the recurrence was related to original wound defect size . Overall complications of 21% to 58.7% and recurrences of 16% after a mean follow‐up of 55 months have been noted, with more recurrences over the ischial tuberosities .…”