Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap

Abstract

Background:Surgical treatment of pressure ulcers is challenging for high recurrence rates. Deepithelialized flaps have been used previously with the aim to eliminate shearing forces and the cone of pressure (COP) effect. The goal of this study is to adopt a standardized protocol and evaluate if 2 different flap techniques affect outcomes.Methods:The novel COP flap is illustrated. Twenty patients were prospectively treated with flap coverage over a 36-month period. According to the flap type, patients were assigned to 2 groups: group 1 with 11 patients treated with the COP flap and group 2 with 9 patients treated with conventional flap without anchoring technique. We adopted a standardized protocol of debridement, tissue cultures, and negative-pressure wound therapy. Rotation fasciocutaneous flaps were used for both groups and mean follow-up was 19 months. The COP flap is a large deepithelialized rotation flap inset with transcutaneous nonabsorbable bolster sutures. The 2 groups were comparable for demographics and ulcer location and size (P < 0.05). Five patients showed positive cultures and were treated with antibiotics and negative-pressure therapy before surgery.Results:Recurrence rates were 12% in the COP flap group and 60% in the conventional flap coverage group (P < 0.001). Results were compared at 16-month follow-up.Conclusions:The COP flap significantly reduces recurrences and eliminates shearing forces, suture ripping, and tension on superficial soft-tissue layers. The technique can be applied to both ischial and sacral pressure sores. The flap provides padding over bony prominence without jeopardizing flap vascularity.

Volumetric Evaluation of Dead Space in Ischial Pressure Injuries Using Magnetic Resonance Imaging: A Case Series

“…The defects that arise from ischial PIs are often described as an “inverted ice cream” or “cone of pressure” because of their morphologic characteristics 12 . Because of their presentation, it is difficult to evaluate these wounds accurately through physical examination alone.…”

Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group

“…Several surgical techniques and modifications have been described over the past decades, but limited clinical outcomes data have been published. In a 2022 Cochrane review, 40 only one RCT was identified that investigated the surgical reconstruction of PIs 41 . In this study, Gargano et al 41 enrolled 20 patients randomized to either a conventional flap or a novel cone flap; the novel cone cohort had reduced recurrences compared with the standard flap group.…”

“…In a 2022 Cochrane review, 40 only one RCT was identified that investigated the surgical reconstruction of PIs 41 . In this study, Gargano et al 41 enrolled 20 patients randomized to either a conventional flap or a novel cone flap; the novel cone cohort had reduced recurrences compared with the standard flap group. Based on the current clinical evidence, there are no clear recommendations on the preferred surgical management for stage 3 and 4 PIs 42 .…”

“…The working group does acknowledge prior but limited work in this space. For example, Chen et al 94 previously proposed an algorithm for assessing when patients with a PI are candidates for flap closure, and Gargano et al 41 have made recommendations for different flap-based techniques. A Swedish postoperative algorithm described the management of patients that underwent flap-based surgical reconstruction 95 .…”

Nurses’ Bedsore-Related Knowledge in Sanandaj Educational Healthcare Centers

“…This common, chronic, but preventable damage, occurs in populations with a high level of risk (2). These wounds gradually recover as a result of excessive pressure on vascular capillary systems.…”