Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

  • Tran, Bao Ngoc N. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Chen, Austin D. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Kamali, Parisa (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Singhal, Dhruv (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Lee, Bernard T. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Fukudome, Eugene Y. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School)
  • Received : 2018.03.16
  • Accepted : 2018.07.03
  • Published : 2018.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

Keywords

References

  1. Lyder CH. Pressure ulcer prevention and management. JAMA 2003;289:223-6. https://doi.org/10.1001/jama.289.2.223
  2. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA 2006;296:974-84. https://doi.org/10.1001/jama.296.8.974
  3. Goodman CM, Cohen V, Armenta A, et al. Evaluation of results and treatment variables for pressure ulcers in 48 veteran spinal cord-injured patients. Ann Plast Surg 1999;42:665-72. https://doi.org/10.1097/00000637-199906000-00015
  4. Baumgarten M, Margolis D, Berlin JA, et al. Risk factors for pressure ulcers among elderly hip fracture patients. Wound Repair Regen 2003;11:96-103. https://doi.org/10.1046/j.1524-475X.2003.11204.x
  5. Lindholm C, Sterner E, Romanelli M, et al. Hip fracture and pressure ulcers: the Pan-European Pressure Ulcer Study: intrinsic and extrinsic risk factors. Int Wound J 2008;5:315-28. https://doi.org/10.1111/j.1742-481X.2008.00452.x
  6. Ricci JA, Bayer LR, Orgill DP. Evidence-based medicine: the evaluation and treatment of pressure injuries. Plast Reconstr Surg 2017;139:275e-286e. https://doi.org/10.1097/PRS.0000000000002850
  7. Keys KA, Daniali LN, Warner KJ, et al. Multivariate predictors of failure after flap coverage of pressure ulcers. Plast Reconstr Surg 2010;125:1725-34. https://doi.org/10.1097/PRS.0b013e3181d51227
  8. Kenneweg KA, Welch MC, Welch PJ. A 9-year retrospective evaluation of 102 pressure ulcer reconstructions. J Wound Care 2015;24 Suppl 4a:S12-21. https://doi.org/10.12968/jowc.2015.24.Sup4a.S12
  9. Biglari B, Buchler A, Reitzel T, et al. A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients. Spinal Cord 2014;52:80-3. https://doi.org/10.1038/sc.2013.130
  10. Yamamoto Y, Tsutsumida A, Murazumi M, et al. Long-term outcome of pressure sores treated with flap coverage. Plast Reconstr Surg 1997;100:1212-7. https://doi.org/10.1097/00006534-199710000-00021
  11. Kierney PC, Engrav LH, Isik FF, et al. Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine. Plast Reconstr Surg 1998;102: 765-72. https://doi.org/10.1097/00006534-199809010-00022
  12. Bamba R, Madden JJ, Hoffman AN, et al. Flap reconstruction for pressure ulcers: an outcomes analysis. Plast Reconstr Surg Glob Open 2017;5:e1187. https://doi.org/10.1097/GOX.0000000000001187
  13. Lim S, Kim BD, Kim JY, et al. Preoperative albumin alone is not a predictor of 30-day outcomes in pressure ulcer patients: a matched propensity-score analysis of the 2006-2011 NSQIP datasets. Ann Plast Surg 2015;75:439-47. https://doi.org/10.1097/SAP.0000000000000124
  14. Diamond S, Moghaddas HS, Kaminski SS, et al. National outcomes after pressure ulcer closure: inspiring surgery. Am Surg 2016;82:903-6.
  15. Filius A, Damen TH, Schuijer-Maaskant KP, et al. Cost analysis of surgically treated pressure sores stage III and IV. J Plast Reconstr Aesthet Surg 2013;66:1580-6. https://doi.org/10.1016/j.bjps.2013.05.014
  16. Hirshberg J, Rees RS, Marchant B, et al. Osteomyelitis related to pressure ulcers: the cost of neglect. Adv Skin Wound Care 2000;13:25-9.
  17. Griffith BH, Schultz RC. The prevention and surgical treatment of recurrent decubitus ulcers in patients with paraplegia. Plast Reconstr Surg Transplant Bull 1961;27:248-60. https://doi.org/10.1097/00006534-196103000-00002
  18. Karaca AR, Binns JH, Blumenthal FS. Complications of total ischiectomy for the treatment of ischial pressure sores. Plast Reconstr Surg 1978;62:96-9. https://doi.org/10.1097/00006534-197807000-00015
  19. Anthony JP, Huntsman WT, Mathes SJ. Changing trends in the management of pelvic pressure ulcers: a 12-year review. Decubitus 1992;5:44-51.
  20. Lindan O, Greenway RM, Piazza JM. Pressure distribution on the surface of the human body. I. Evaluation in lying and sitting positions using a "bed of springs and nails." Arch Phys Med Rehabil 1965;46:378-85.
  21. Evans GR, Dufresne CR, Manson PN. Surgical correction of pressure ulcers in an urban center: is it efficacious? Adv Wound Care 1994;7:40-6.
  22. Tavakoli K, Rutkowski S, Cope C, et al. Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study. Br J Plast Surg 1999;52:476-9. https://doi.org/10.1054/bjps.1999.3126
  23. Niazi ZB, Salzberg CA, Byrne DW, et al. Recurrence of initial pressure ulcer in persons with spinal cord injuries. Adv Wound Care 1997;10:38-42.
  24. Salzberg CA, Byrne DW, Cayten CG, et al. A new pressure ulcer risk assessment scale for individuals with spinal cord injury. Am J Phys Med Rehabil 1996;75:96-104. https://doi.org/10.1097/00002060-199603000-00004
  25. Goltsman D, Munabi NC, Ascherman JA. The association between smoking and plastic surgery outcomes in 40,465 patients: an analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets. Plast Reconstr Surg 2017;139:503-11. https://doi.org/10.1097/PRS.0000000000002958

Cited by

  1. Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept vol.5, pp.1, 2018, https://doi.org/10.1038/s41394-019-0173-0
  2. Socioeconomic effects of pressure ulcer vol.64, pp.1, 2021, https://doi.org/10.5124/jkma.2021.64.1.11
  3. Case Report: Surgical Closure of Chronic Soft Tissue Defects Using Extracellular Matrix Graft Augmented Tissue Flaps vol.7, pp.None, 2018, https://doi.org/10.3389/fsurg.2020.559450