Reconstruction of pressure ulcers with flaps in a tertiary care centre
DOI:
https://doi.org/10.18203/2349-2902.isj20210378Keywords:
Pressure ulcers, Surgery, Flap coverAbstract
Background: Patients with pressure ulcers have multiple risk factors and develop various post- operative complications. The purpose of the study is to analyse the outcome of management of pressure ulcers with different flaps.
Methods: This is a retrospective study done in a series of patients who underwent flap reconstruction of pressure ulcers between 2016 and 2019 in the Department of Plastic and Reconstructive Surgery, Thanjavur medical college, Tamilnadu, India. Totally twenty-eight patients were operated for stage III and stage IV pressure ulcers with various types of flaps depending upon the site of pressure ulcers. Post operatively flaps were monitored for viability and post-operative complications.
Results: Total 22 males, 5 females and 1 male child had undergone surgery for pressure ulcers. The age group ranged from 3years to 62 years with an average of 37 years. The sites of the pressure ulcers were as follows: 14 (50%) sacral; 10 (35.7%) ischial; 3 (10.7%) trochanteric and 1 (3.6%) multiple pressure ulcers. Most of the patients (60.7%) had traumatic paraplegia and developed pressure ulcers. 18 patients with stage III and 10 patients with stage IV pressure sores were operated with different flaps. Duration of treatment ranged from 29 to 118 days. The mean hospitalization was 78 days.
Conclusions: Effort is needed to prevent the development of pressure ulcers through the early identification of risk and early implementation of preventive measures. Flap cover is ideal to prevent recurrence. Post-operative follow- up with physiotherapy and rehabilitation are very important.
Metrics
References
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA; 2019.
Cushing CA, Phillips LG. Evidence-based medicine: pressure sores. Plast Reconstr Surg. 2013; 132:1720-32.
Moore Z, Avsar P, Conaty L, Moore DH, Patton D, O'Connor T. The prevalence of pressure ulcers in Europe, what does the European data tell us: a systematic review. J Wound Care. 2019;28:710-19.
Hauck KD, Wang S, Vincent C, Smith PC. Healthy life-years lost and excess bed-days due to 6 patient safety incidents. Med Care. 2017;55:125–30.
Agrawal K, Chauhan N. Pressure ulcers: Back to the basics. Ind J Plast Surg. 2012;45:244-54.
Shahin ES, Dassen T, Halfens RJ. Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. Int J Nurs Stud. 2009;46:413-21.
Leblebici B, Turhan N, Adam M, Akman MN. Clinical and epidemiologic evaluation of pressure ulcers in patients at a university hospital in Turkey. J Wound Ostomy Continence Nurs. 2007;34:407-11.
Chauhan VS, Goel S, Kumar P, Srivastava S, Shukla VK. The prevalence of pressure ulcers in hospitalized patients in a university hospital in India. J Wound Care. 2005;14:36-7.
Duci SB, Arifi HM, Selmani ME, et al. Surgical Treatment of 55 Patients with Pressure Ulcers at the Department of Plastic and Reconstructive Surgery Kosovo during the Period 2000-2010: A Retrospective Study. Plast Surg Int. 2013;2013:129692.
Schiffman J, Golinko MS, et al.Operative debridement of pressure ulcers. World J Surg. 2009;33:1396–402
Husain T. An experimental study of some pressure effects on tissues, with reference to the bedsore problem. J Pathol Bacteriol. 1953;66:347-58.
Kuwahara M, Tada H, Mashiba K, Yurugi S, Iioka H, Niitsuma K, et al. Mortality and recurrence rate after pressure ulcer operation for elderly long-term bedridden patients. Ann Plast Surg. 2005;54:629-32.
Laing TA, Ekpete N, Oon S, Carroll SM. Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure? J Wound Ostomy Continence Nurs. 2010;37:615-8.
Levine SM, Sinno S, Levine JP, Saadeh PB. An evidence-based approach to the surgical management of pressure ulcers. Ann Plast Surg. 2012;69:482-4.
Reddy M, Gill SS, Kalkar SR, Wu W, Anderson PJ, Rochon PA. Treatment of pressure ulcers: A systematic review. J Am Med Assoc. 2008;300:2647–62.
Chang SH. Anterolateral thigh island pedicled flap in trochanteric pressure sore reconstruction. J Plast Reconstr Aesthet Surg. 2007;60:1074-5.
Ichioka S, Okabe K, Ohura N, et al. Versatility of the Limberg flap and the V-Y flap (based on a distal perforator) for covering sacral ulcers. Scandinavian J Plast Reconstruct Surg Hand Surg. 2007;41:65-9.
Wong CH, Tan BK, Song C. The perforator-sparing buttock rotation flap for coverage of pressure sores. Plast Reconstr Surg. 2007;119:1259-66.
Jósvay J, Sashegyi M, Kelemen P, Donáth A. Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores. J Plast Reconstr Aesthet Surg. 2006;59:137-41.
Aslan G, Tuncali D, Bingul F, Ates L, Yavuz N. The “duck” modification of the tensor fascia lata flap. Ann Plast Surg. 2005;54:637-9.
Alderden J, Whitney JD, Taylor SM, Zaratkiewicz S. Risk profile characteristics associated with outcomes of hospital-acquired pressure ulcers: a retrospective review. Critic Care Nurse. 2011;31(4):30-43.
Downloads
Published
How to Cite
Issue
Section
