Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?

Hdl Handle:
http://hdl.handle.net/10147/207617
Title:
Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?
Authors:
Laing, Tereze A; Ekpete, Neville; Oon, Shane; Carroll, Sean M
Affiliation:
Department of Plastic and Reconstructive Surgery, St. Vincent's University, Hospital, Elm Park, Dublin, Ireland. terezelaing@yahoo.com
Citation:
J Wound Ostomy Continence Nurs. 2010 Nov-Dec;37(6):615-8.
Journal:
Journal of wound, ostomy, and continence nursing : official publication of The, Wound, Ostomy and Continence Nurses Society / WOCN
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207617
DOI:
10.1097/WON.0b013e3181f90d03
PubMed ID:
21052028
Abstract:
BACKGROUND: The surgical management of pressure ulcers traditionally involved staged procedures, with initial debridement of necrotic or infected material followed by reconstruction at a later date when the wound was deemed viable and free of gross infection. However, over the past decade, it has been suggested that a single-stage procedure, combining initial debridement and definitive reconstruction, may provide advantages over staged surgery. We present our experience with the staged approach and review the current evidence for both methods. SUBJECTS AND SETTINGS: : We reviewed medical records of all patients referred to our service for pressure ulcer management between October 2001 and October 2007. The National Rehabilitation Hospital is the national center in Ireland for primary rehabilitation of adults and children suffering from spinal and brain injury, serving patients locally and from around the country. METHODS: All subjects who were managed surgically underwent a 2-stage procedure, with initial debridement and subsequent reconstruction. The main outcome measures were length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing. RESULTS: Forty-one of 108 patients with 58 pressure ulcers were managed surgically. All patients underwent initial surgical debridement and 20 patients underwent subsequent pressure ulcer reconstruction. Postreconstructive complications occurred in 5 patients (20%). The mean time to complete ulcer healing was 17.4 weeks. Partial flap necrosis occurred in 3 patients, but there were no episodes of flap failure. CONCLUSIONS: We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.
Language:
eng
MeSH:
Adult; Aged; Debridement; Female; Humans; Ireland/epidemiology; Length of Stay/statistics & numerical data; Male; Middle Aged; Necrosis; Postoperative Complications/surgery; Pressure Ulcer/mortality/*surgery; Reconstructive Surgical Procedures/*methods; Retrospective Studies; Surgical Flaps; Treatment Outcome; Wound Healing
ISSN:
1528-3976 (Electronic); 1071-5754 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLaing, Tereze Aen_GB
dc.contributor.authorEkpete, Nevilleen_GB
dc.contributor.authorOon, Shaneen_GB
dc.contributor.authorCarroll, Sean Men_GB
dc.date.accessioned2012-02-01T10:33:00Z-
dc.date.available2012-02-01T10:33:00Z-
dc.date.issued2012-02-01T10:33:00Z-
dc.identifier.citationJ Wound Ostomy Continence Nurs. 2010 Nov-Dec;37(6):615-8.en_GB
dc.identifier.issn1528-3976 (Electronic)en_GB
dc.identifier.issn1071-5754 (Linking)en_GB
dc.identifier.pmid21052028en_GB
dc.identifier.doi10.1097/WON.0b013e3181f90d03en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207617-
dc.description.abstractBACKGROUND: The surgical management of pressure ulcers traditionally involved staged procedures, with initial debridement of necrotic or infected material followed by reconstruction at a later date when the wound was deemed viable and free of gross infection. However, over the past decade, it has been suggested that a single-stage procedure, combining initial debridement and definitive reconstruction, may provide advantages over staged surgery. We present our experience with the staged approach and review the current evidence for both methods. SUBJECTS AND SETTINGS: : We reviewed medical records of all patients referred to our service for pressure ulcer management between October 2001 and October 2007. The National Rehabilitation Hospital is the national center in Ireland for primary rehabilitation of adults and children suffering from spinal and brain injury, serving patients locally and from around the country. METHODS: All subjects who were managed surgically underwent a 2-stage procedure, with initial debridement and subsequent reconstruction. The main outcome measures were length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing. RESULTS: Forty-one of 108 patients with 58 pressure ulcers were managed surgically. All patients underwent initial surgical debridement and 20 patients underwent subsequent pressure ulcer reconstruction. Postreconstructive complications occurred in 5 patients (20%). The mean time to complete ulcer healing was 17.4 weeks. Partial flap necrosis occurred in 3 patients, but there were no episodes of flap failure. CONCLUSIONS: We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshDebridementen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIreland/epidemiologyen_GB
dc.subject.meshLength of Stay/statistics & numerical dataen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNecrosisen_GB
dc.subject.meshPostoperative Complications/surgeryen_GB
dc.subject.meshPressure Ulcer/mortality/*surgeryen_GB
dc.subject.meshReconstructive Surgical Procedures/*methodsen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshSurgical Flapsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshWound Healingen_GB
dc.titleSurgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?en_GB
dc.contributor.departmentDepartment of Plastic and Reconstructive Surgery, St. Vincent's University, Hospital, Elm Park, Dublin, Ireland. terezelaing@yahoo.comen_GB
dc.identifier.journalJournal of wound, ostomy, and continence nursing : official publication of The, Wound, Ostomy and Continence Nurses Society / WOCNen_GB
dc.description.provinceLeinster-
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