Ten years of myocutaneous flaps for pressure ulcers in patients with spinal lesions: Analysis of complications in the framework of a specialised medical-surgical pathway

Lefèvre, C.; Bellier-Waast, F.; Lejeune, F.; Duteille, Franck; Kiény, P.; Fort, M. Le; Perrouin-Verbe, B.

doi:10.1016/j.bjps.2018.07.007

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…Wound-coverage procedures using a surgical flap after pressure relief and adequate nutrition are indicated in patients with pressure ulcers resistant to conservative management. Various flaps, such as the gluteus maximus myocutaneous flap designed in a V-Y pattern or rotation fashion, exist for sacral-pressure ulcer reconstruction [1,3,30,31]. Recently, the perforator flap has played an important role in reconstructions because of lower donor-site morbidity and free rotational arc [2,[32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon

Hsu

Chu

Chen

et al. 2022

JPM

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Background: In this study, we aimed to analyze the clinical efficacy of closed-incision negative pressure wound therapy (CiNPWT) when combined with primary closure (PC) in a patient with pressure ulcers, based on one single surgeon’s experience at our medical center. Methods: We retrospectively reviewed the data of patients with stage III or IV pressure ulcers who underwent reconstruction surgery. Patient characteristics, including age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, application of CiNPWT to reconstructed wounds, duration of hospital stay, and wound complications were analyzed. Results: Operation time (38.16 ± 14.02 vs. 84.73 ± 48.55 min) and duration of hospitalization (36.78 ± 26.92 vs. 56.70 ± 58.43 days) were shorter in the PC + CiNPWT group than in the traditional group. The frequency of debridement (2.13 ± 0.98 vs. 2.76 ± 2.20 times) was also lower in the PC + CiNPWT group than in the traditional group. The average reconstructed wound size did not significantly differ between the groups (63.47 ± 42.70 vs. 62.85 ± 49.94 cm2), and there were no significant differences in wound healing (81.25% vs. 75.38%), minor complications (18.75% vs. 21.54%), major complications (0% vs. 3.85%), or mortality (6.25% vs. 10.00%) between the groups. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable.

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Section: Discussionmentioning

confidence: 99%

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon

Hsu

Chu

Chen

et al. 2022

JPM

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“…Techniques defined for the repair of ischial pressure ulcers include using phytocutaneous flaps, perforator flaps, and myocutaneous flaps. [15][16][17] Fasciocutaneous rotation flaps were employed most frequently in this study to treat ischial pressure ulcers.…”

Section: Discussionmentioning

confidence: 99%

Management and treatment of pressure ulcers: Clinical experience

Irmak¹

2018

Sisli Etfal

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P ressure ulcers are frequently observed in bedridden patients and can lead to major problems when left untreated. There is a high prevalence in hospitalized patients requiring long-term treatment. [1] They are a major reason for hospitalization in immobile patients, and are often seen in elderly patients with impaired sensory function. This represents a significant cost to the healthcare system, and the mortality rate in this patient group is unnecessarily high. Risk factors for pressure ulcers other than advanced age include neurological defects, malnutrition, chronic disease, and immobility. In spite of the development of preventive health services, more than 90% of patients with a spinal cord injury have been reported to develop pressure ulcers, especially in developing countries. [2] The prevalence among hospitalized patients has been as much as 18.1% in Europe, [3] and in studies performed in our country, the Objectives: Pressure ulcers are a common healthcare problem, particularly among hospitalized patients who need long-term treatment; however, preventive medicine can reduce the prevalence. A multidisciplinary approach is fundamental to providing proper care, and the general health status and cooperation of the patient determine treatment modalities. Simple methods can prevent pressure ulcers and their recurrence. The aim of this study was to share clinical experience and evaluate the approach and treatment modalities used for pressure ulcers. Methods: Fifty-two patients hospitalized with the indication of pressure ulcers were evaluated retrospectively. Age, sex, localization of the decubitus ulcer, treatment method, comorbid diseases, and any postoperative complications were analyzed. Results: Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed. Conclusion: The most important point with regard to pressure ulcers is prevention. Healthcare system expenses can be significantly reduced by preventing the formation of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment are provided in the early period. The role of the plastic surgeon in advanced stages is to perform reconstruction in appropriate cases and to educate patients and their caregivers with the aim of preventing recurrence.

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“…High rates of flap dehiscence and ulcer recurrence after the surgical management of pressure ulcers have been reported, wherein successful coverage rates ranged between 18%-97%, with wide variation in the documentation and analysis of surgical outcomes 13,16,17) . Keys et al analyzed the risk factors associated with flap dehiscence and ulcer recurrence in 227 surgeries performed on 135 patients; they found that patients with risk factors, such as age < 45 years, low serum albumin levels < 3.5 g/dL, previous operative failure at the same site, poor diabetes control (HbA1c > 6%), and ischial wound location, showed a significant trend toward recurrence in both the early and late periods after flap coverage 18) .…”

Section: Postoperative Complications and Risk Factorsmentioning

confidence: 99%

Ischial and Sacral Pressure Ulcers

Abe

Mineda

Yamashita

et al. 2022

International Journal of Surgical Wound Care

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Background: Pressure ulcers remain a challenge for plastic surgeons to effectively manage because of the patient's underlying physical condition, weakness, risk factors associated with the diagnosis, and resultant insufficient wound healing that results in incomplete treatment or recurrence after surgery. This review describes and analyzes the current literature regarding the management of pressure ulcers. Methods: Risk factors primarily associated with wound dehiscence and recurrence were identified via a PubMed literature search using "ischial pressure ulcers, sacral pressure ulcers, and surgical coverage" as keywords. We analyzed and compared them to data from the Committee of the Japanese Society of Pressure Ulcers in 2016 and our facility. Results: Many published reports contain pedagogical comments on the successful management of pressure ulcers that remain significant. Some reported risk factors associated with flap dehiscence and ulcer recurrence are age, low serum albumin levels, previous operative failures at the same site, and ischial ulcers. The prevalence of deep pressure ulcers at the sacrum was more than three times higher than that at any other site. At our facility, the most frequently performed surgeries were for ischial ulcers, and 86% of pressure ulcers healed after surgery. Conclusions: Surgical site infection and surgical time were independent risk factors associated with wound dehiscence in the early phase after reconstruction. The effectiveness of closed wound management with negative-pressure wound therapy has been reported to be satisfactory for reconstructive surgeries with flaps for refractory pressure ulcers.

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Ten years of myocutaneous flaps for pressure ulcers in patients with spinal lesions: Analysis of complications in the framework of a specialised medical-surgical pathway

Cited by 17 publications

References 25 publications

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon

Management and treatment of pressure ulcers: Clinical experience

Ischial and Sacral Pressure Ulcers

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