Surgical treatment of pressure ulcers: an 11-year experience at the Department of Plastic and Reconstructive Surgery of Hospital of Kaunas University of Medicine

Abstract

The aim of this study was to evaluate morphological characteristics of pressure ulcers, methods of surgical treatment and its effectiveness in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital. Material and methods. A retrospective data analysis of 139 patients with pressure ulcers treated in the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007 was performed. Results. A total of 139 patients were surgically treated for pressure ulcers at the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007. Eighty-one patients were treated repeatedly (from 1 to 7 admissions; M=1). Pressure ulcers were healed completely in 94 patients who underwent surgery during the treatment in the hospital; in 45 patients who underwent surgical treatment, pressure ulcers were partially healed, and on discharge from hospital, only small wounds were left. Pressure ulcers most commonly occur in tuber ischii area (69 cases). The mean age of patients was 42±13.65 years (M=31); pressure ulcers were for 8.9±8.5 months on average (M=31). At admission to Kaunas University of Medicine Hospital, the mean size of pressure ulcers was 42.62±53.27 cm2 (M=10). The results showed that the size of pressure ulcers depends on the duration of paraplegia (P<0.05). In 93 cases, pressure ulcers were treated using myocutaneous flaps; 17 of them were closed with V-Y advancement technique over the sacral area, 35 were closed with m. gluteus rotation flap, and in 41 cases, V-Y advancement technique using hamstring flaps was used. Conclusions. In patients with paraplegia, the first pressure ulcer occurs after 74.79±61.34 months from the onset of the disease. Pressure ulcers most commonly occur over tuber ischii area. The most effective surgical treatment of pressure ulcers is closure of the wound using myocutaneous flaps (use of the hamstrings); fasciocutaneous flaps were the most commonly used method in patients who underwent surgery for the second time.

Risk factors for recurrence of pressure ulcers after defect reconstruction

“…Pressure ulcers commonly occur in areas of the body where external pressure leads to a hypoperfusion of local tissue. 1,2 In Europe, the prevalence of pressure ulcers ranges from 8 to 54% in an intensive care unit setting. 3 In long-term care, the incidence of pressure ulcer was described in up to 24% in the healthy US population.…”

Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper

“…A literature search was performed on MEDLINE and EMBASE databases for key terms of “pressure ulcer recurrence,” “recidivism,” or “healed.” The literature search resulted in 22 references. Of those, 14 articles were chosen for literature review based on the overall topic of the paper with relationship to “healed” or “recurrent pressure ulcers.” The other eight references had one of the terms mentioned but were excluded because they did not relate to the overall topic and did not specifically use terms related to pressure ulcer healing. The authors of this white paper divided the 14 articles among themselves and created evidence tables.…”

“…Of those, 14 articles were chosen for literature review based on the overall topic of the paper with relationship to "healed" or "recurrent pressure ulcers." [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The other eight references had one of the terms mentioned but were excluded because they did not relate to the overall topic and did not specifically use terms related to pressure ulcer healing. The authors of this white paper divided the 14 articles among themselves and created evidence tables.…”

“…A review of the literature and discussion with thought leaders in the area of pressure ulcers confirmed this lack of a standardized nomenclature . Regulatory bodies and payors require specific terminology for documentation, quality monitoring, and reimbursement .…”

“…A review of the literature and discussion with thought leaders in the area of pressure ulcers confirmed this lack of a standardized nomenclature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Regulatory bodies and payors require specific terminology for documentation, quality monitoring, and reimbursement. 15 The current system used by payors and regulators has been developed independent of a scientific basis or formalized research.…”