Surgical treatment of pressure ulcers: 20-year experience

Schryvers, Orpha I.; Stranc, M.F.; Nance, Patricia W.

doi:10.1053/apmr.2000.17828

Cited by 122 publications

(94 citation statements)

References 30 publications

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“…18 This made comparison with our results difficult, but we were able to confirm in our study that the most common complication was suture line dehiscence. Schryvers et al had a total rate of complications of 31%, which was significantly higher than our rate of 21%.…”

Section: Discussionmentioning

confidence: 50%

“…We had a similar distribution of ulcer localizations in patients as Schryvers et al, who reported that 43% of patients had ischial ulcers, 20% sacral and 19.4% trochanteric. 18 Our patients had 44% ischial ulcers, 22% sacral and 19% trochanteric.…”

Section: Discussionmentioning

confidence: 60%

“…Authors showed that trochanteric reconstructions had the highest rate of complications (35%), followed by sacral (30%) and ischial (30%). 18 However, Foster et al reported different findings in an earlier study showing that ischial reconstructions had the highest rate of complications (42%), followed by sacral (20%) and trochanteric (15%). 19 We chose not to report on the rate of complications according to reconstruction localization, because the focus of our study was on the type of flap used; however, we did show results on the occurrence of pressure ulcer localizations.…”

Section: Discussionmentioning

confidence: 93%

“…The scientific literature points to specific factors in flap surgery that cause complications such as the separation of the flap from primary blood sources, temporary reduction in circulation and expansion of wound areas during surgery. 10,[16][17][18][19] The localization of pressure ulcers influences the appearance of complications, probably due to positioning and care of the ulcer following surgery. Researchers have documented the rate of complications according to pressure ulcer reconstruction localizations, and show varying results.…”

Section: Discussionmentioning

confidence: 99%

“…21 The total hospital stay in our study was more than three times shorter as in Schryvers et al, that is, 25 104 days for 352 patients (71.3 days per patient) compared with 41 559 days for 168 patients (247.4 days per patient). 18 Shorter hospital stays suggest greater efficacy of treatment and lower ensuing costs. 21 There is currently no mention in the scientific literature of complications according to specific flaps.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients

et al. 2013

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Study design: A retrospective study reporting specific complications of certain skin flaps for treating pressure ulcers. Objectives: To describe the rate and type of complications after pressure ulcer surgery in patients with spinal cord injury. Setting: Germany, Rheinland Pfalz. Methods: We collected data from 352 patients treated with 421 skin flaps to determine the rate and type of complications of each skin flap used. Results: In this study, we analyzed the results of 421 skin flaps in 352 patients with a total of 657 pressure ulcers from January 2006 to December 2010. Our patients had ischial, pelvic, sacral, trochanteric and lower extremity ulcers. Ischial ulcers were most common, followed by sacral and trochanteric ulcers. There were 87 complications in 421 flaps, which was an overall rate of 21%. Suture line dehiscence was the most common complication with 27 cases (31%), followed by 22 cases of infection (25.2%), 17 cases of hematoma (19.5%), 12 cases of partial necrosis (13.7%) and 9 cases of total flap necrosis (10.3%). Conclusion: Pressure ulcers in spinal cord-injured patients are very common and difficult and expensive to treat. The high rate of complications and the associated costs suggest the importance of evaluating the efficacy of treatment options. Conservative procedures have been standardized, but there still has been limited success in establishing guidelines on how to manage complications arising from flap surgery. Our extensive documentation of flap plastics will be useful managing complications after the surgical treatment of pressure ulcers in spinal cord-injured patients.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients

et al. 2013

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Mechanical and Thermal Injury

Kennedy¹,

Burd²

2004

Rook's Textbook of Dermatology

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The skin is constantly subjected to both internal and external mechanical forces, so that for experimental purposes it may be impossible to determine what constitutes the normal resting state. These forces are likely to be as important in the maintenance of the structural integrity of the connective tissues of the skin [1,2] as they are with bone, which becomes demineralized during the protracted absence of normal gravitational force during space travel [3]. In contrast to events in the whole organism, isolated human dermal fibroblasts in culture make more collagen when subjected to reduced gravity [4]. Many normal biochemical functions of the skin are dependent on appropri-ate mechanical forces, and when these become excessive, as in lymphoedema, protease inhibitors are released with many deleterious consequences [5].Healthy skin is well adapted to resist the adverse effects of a wide range of mechanical injuries [6]. These include friction, pressure, contusion, laceration, suction and vibration. The clinical consequence of injury will depend on characteristics of the noxious stimulus, such as its intensity and duration. Factors related to the skin also influence the response; thus, the same degree of friction may produce a blister in one person but no visible change in another. Time is required for adaptive responses, such as callus formation and lichenification, to occur.

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