Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

Abstract

Background:Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage.Methods:This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection.Results:All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34).Conclusions:Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.

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 common known predictive factors for complications in pressure ulcer reconstruction are BMI < 18, smoking, osteomyelitis, diabetes, ulcers located over the ischial tuberosity, and a previous reconstruction . In the current study, no correlation was found between complications and BMI, diabetes, or the proportion of patients with multiple wounds.…”

“…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 . Previous reconstruction has been shown to be a risk factor for postoperative dehiscence in ischial tuberosity pressure ulcers as well, and wound dehiscence in general is the most common complication .…”

“…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 . Previous reconstruction has been shown to be a risk factor for postoperative dehiscence in ischial tuberosity pressure ulcers as well, and wound dehiscence in general is the most common complication . Typical risk factors for wound‐healing complications after pressure ulcer reconstruction include BMI < 18, smoking, osteomyelitis, diabetes, and ulcers located over the ischial tuberosity …”

Complex reconstructive surgery for a recurrent ischial pressure ulcer with contralateral muscle

“…Unfortunately, despite adequate flap coverage, nearly one-third of patients will develop a recurrent pressure ulcer [4,5] . A history of previous pressure ulcer increases the risk of developing a second pressure ulcer, particularly in the ischial region [1,6] .…”