Reconstructive surgery for treating pressure ulcers

Norman, Gill; Wong, Jason; Amin, Kavit; Dumville, Jo C; Pramod, Susy

doi:10.1002/14651858.cd012032.pub3

Cited by 10 publications

(6 citation statements)

References 89 publications

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“…Meanwhile, the average age of patients with pressure injury has gradually increased, with worse general condition and decreased physical function. For grade III‐IV pressure injury with surgical indications, surgical debridement and surgical reconstruction can greatly help shorten the time of wound healing and hospitalisation 21‐23 . Some elderly patients with pressure injury may not be able to tolerate surgical treatment due to the high risks of surgery and anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Within‐patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers

Zhang

Sun

Zhu

et al. 2022

International Wound Journal

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Pressure injury often seriously affects the life quality of aged patients, especially the long-term bedridden casualties. Widely adopted by different disciplines, negative pressure suction has its role in pressure injury. Microskin implantation has been demonstrated powerful in increasing the expansion ratio of donor area-derived skin and accelerating wound healing by forming "skin islands". The study was designed to evaluate the efficacy and safety of additional use of bedside microskin implantation in the palliative care of pressure injury of aged patients who cannot tolerate surgical treatment as a supplement for standard negative pressure suction. An open-label within-patient RCT was conducted in aged patients with pressure injury. Sixteen patients were enrolled. After granulation tissues formed, half of a pressure injury was randomised to receive the negative pressure suction as the control group, and the other half exposed to additional bedside microskin implantation as the experimental group. Efficacy was evaluated within 1 month after treatment, and the primary endpoints included the wound healing rate and pressure ulcer scale for healing (PUSH) scores. The secondary outcomes included survival rate of implanted microskin, pain intensity assessment, satisfaction surveys from patients or their family, and pressure ulcer healing complications. Sixteen patients completed the study. After 14 days of operation, 5.63 ± 1.78 out of 10 pieces of implanted microskin survived and formed neonatal epithelium.The wound healing rates of the control group and the experimental group at 1 month were (26.17 ± 9.03%) and (35.95 ± 16.02%), respectively (P < .01). The mean PUSH score before the surgery was 12.38 ± 2.23. At 1 month after Ming Zhang, Jiachen Sun, and Minhui Zhu contributed equally to the manuscript.

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Section: Discussionmentioning

confidence: 99%

Within‐patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers

Zhang

Sun

Zhu

et al. 2022

International Wound Journal

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“…The application of physical methods of bedsores therapy is a separate direction of conservative therapy. It is allowed to use one method alone or as a part of complex therapy, the purpose of which is cleaning of tissue debris, pus, and fibrin [17]. Additionally, regenerative processes are stimulated [18].…”

Section: Therapy Methodsmentioning

confidence: 99%

Bedsores: prevention and treatment (theoretical review)

2022

UMJ

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The incidence of bedsores varies from 3 to 40%, with a maximum of 80% in patients in critical condition for a long time. Purpose: analysis of effective methods of therapy and prevention of bedsores. Object and methods of research. Thirty-one scientific publications from PubMed, Scopus databases since 2020 were analyzed. The analyzed methods included vacuum therapy, ultrasound methods, hydrosurgery, plasma flow method, laser application, electrostimulation, and a complex combination of methods. Results. Many involved methods give the choice in therapy strategy. The most expedient and effective is the complex combination of methods. Conclusion. Currently, a decrease in the incidence of bedsores is not expected; therefore, the analysis of the effectiveness of methods of therapy and prevention of bedsores remains relevant.

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“…39 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.…”

Section: Surgical Intervention For Stage 3 or 4 Pismentioning

confidence: 99%

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

Awad

Stern

Milne

et al. 2023

Adv Skin Wound Care

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OBJECTIVE:Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction. METHODS:An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds.RESULTS: Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention. CONCLUSIONS:The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.

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Reconstructive surgery for treating pressure ulcers

Abstract: Editorial group: Cochrane Wounds Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 10, 2022.

Cited by 10 publications

References 89 publications

Within‐patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers

Within‐patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers

Bedsores: prevention and treatment (theoretical review)

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

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