Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?
Laing, Tereze A Ekpete, Neville Oon, Shane Carroll, Sean M
Laing, Tereze A
Ekpete, Neville
Oon, Shane
Carroll, Sean M
Advisors
Editors
Other Contributors
Date
2012-02-01T10:33:00Z
Date Submitted
Keywords
Other Subjects
Subject 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
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
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
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
ISSN
1528-3976 (Electronic)
1071-5754 (Linking)
1071-5754 (Linking)
eISSN
ISBN
DOI
10.1097/WON.0b013e3181f90d03
PMID
21052028