Flap reconstruction of pressure ulcers in patients with spinal cord injury: a retrospective cohort study.

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY
Ankit Mishra, Mohammed Eldolify, Rebecca Shirley, James K-K Chan
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Abstract

Study design: Retrospective case series.

Objectives: To describe our five-year experience of surgical excision and flap reconstruction of pressure ulcers in individuals with spinal cord injury (SCI).

Setting: Tertiary spinal centre in Stoke Mandeville, United Kingdom.

Methods: All spinal injury patients that underwent surgical reconstruction of pressure ulcers at the Stoke Mandeville Hospital National Spinal Injury Centre between 2018 and 2022 inclusive were included. Ulcers underwent 'pseudotumour' excision followed by either immediate or staged flap reconstruction. The primary outcome was complete healing at one year. Secondary outcomes included flap loss, complications, and return to theatre.

Results: 52 cases were included across 44 patients. 43 cases (82.7%) underwent immediate debridement and reconstruction. The mean number of procedures was 1.9 (range 1-6). Local flaps were used in 22 (41.5%) cases. There was one (1.9%) free flap (anterolateral thigh), eight (15.4%) pedicled flaps, and 21 (39.6%) flaps based on single perforators. 49 cases completed follow-up; 41 (83.7%) were healed at one year after their initial surgery. Immediate reconstructions were 36.7% more likely to achieve healing at this time point than staged cases (P = .028, Fisher's exact). There was partial or total flap loss in 15 (28.8%) cases. Thirty-nine complications were seen in 24 (46.2%) cases. Twenty-three cases (44.2%) required returns to theatre.

Conclusions: Surgical debridement with flap reconstruction is a safe and reliable treatment approach for pressure ulcers in those with SCI, with a complication rate comparable to existing literature. Immediate flap reconstruction and local flap designs may be associated with a lower risk of complications and higher healing rates.

脊髓损伤患者压疮皮瓣重建:一项回顾性队列研究。
研究设计:回顾性病例系列。目的:描述我们在脊髓损伤(SCI)患者压迫性溃疡的手术切除和皮瓣重建方面的五年经验。地点:英国斯托克曼德维尔的第三脊柱中心。方法:纳入2018年至2022年期间在斯托克曼德维尔医院国家脊髓损伤中心接受压疮手术重建的所有脊髓损伤患者。溃疡接受“假肿瘤”切除,然后立即或分阶段皮瓣重建。主要结果是一年内完全愈合。次要结果包括皮瓣丢失、并发症和返回手术室。结果:44例患者共纳入52例。43例(82.7%)立即清创重建。平均手术次数为1.9次(范围1-6)。22例(41.5%)采用局部皮瓣。自由皮瓣1个(1.9%)(大腿前外侧),带蒂皮瓣8个(15.4%),单穿支皮瓣21个(39.6%)。49例完成随访;41例(83.7%)术后1年痊愈。在这个时间点,立即重建的愈合率比分期重建高36.7% (P =。费雪说的是028)。皮瓣部分或全部丢失15例(28.8%)。24例(46.2%)出现并发症39例。23例(44.2%)需要返回手术室。结论:手术清创联合皮瓣重建是一种安全可靠的治疗脊髓损伤压疮的方法,其并发症发生率与现有文献相当。立即皮瓣重建和局部皮瓣设计可能与并发症风险较低和愈合率较高有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Spinal cord
Spinal cord 医学-临床神经学
CiteScore
4.50
自引率
9.10%
发文量
142
审稿时长
2 months
期刊介绍: Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews. Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.
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