Surgical treatment and strategy in patients with multiple pressure sores

Abstract

Pressure sores remain a common health problem, particularly among the physically limited or bedridden elderly, and can cause significant morbidity and mortality. This study aimed to present our surgical treatment and strategy for patients with multiple pressure sores. Between January 2010 and December 2016, 18 patients were enrolled. After adequate debridement, pressure sores were managed based on our treatment protocol. Patients' age, aetiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. A total of 10 men and 8 women (average age, 82.3 years) with a mean follow-up period of 28.3 months (6-72 months) were included. The mean defect area was 63.7 cm . The most common aetiology of the bedridden state was cerebrovascular accident (38.89%), and the most frequent sores were trochanteric pressure sores (53.57%). The average operative time and blood loss were 105.5 minutes and 100.8 mL, respectively. No haemodynamic variation or blood transfusion was noted during the surgery. The complication rate for each sore was 10.7%, including late recurrence. In conclusion, treating pressure ulcers requires careful patient education, intensive multidisciplinary optimisation, and meticulous wound care, and our treatment protocol ensures a shorter surgery time, less bleeding, and low complication rate.

Surgical treatment and strategy in patients with pressure sores

“…These can be musculocutaneous, fasciocutaneous, or perforator flaps and can be applied as rotation, advancement, or island flaps. [ 6 ]…”

“…The skin in elderly patients is lax, and delayed primary closure layer by layer could possibly obliterate the cavity without tension and wound dehiscence. [ 6 ] Plastic surgeons are educated not to resurface pressure sores by primary closure methods because of the high complication rates. In a previous study of primary closure in cases of pressure ulcers, the dehiscence rate was high at 34%.…”

“…All patients were admitted by or had consulted with a single plastic surgeon who specializes in pressure sores. [ 6 – 10 ] Patients and their families were well informed of the operative risks, and they all agreed with the proposed treatment. All reconstructive strategies were guided by our treatment protocol (Fig.…”

“…1 ). [ 6 ] There are no clear criteria for selecting patients for pressure sore surgery, but decision guidelines have been developed. [ 11 – 13 ] Patients with inadequate home facilities or lack of family involvement, or those who were not fit for anesthesia, were excluded.…”

“…In our treatment protocol, we performed vacuum-assisted closure (VAC) therapy, also known as negative pressure wound therapy (NPWT), after wound debridement as a bridge to final reconstruction [ 6 ] (Fig. 2 ).…”