[A multicenter study on the classification and repair effects of stage 4 pressure injury in ischial tuberosity in elderly patients].

Abstract

Objective: To explore the classification and repair effects of stage 4 pressure injury in ischial tuberosity in elderly patients. Methods: This study was a retrospective observational study. From January 2021 to December 2022, 45 elderly patients with stage 4 pressure injury in ischial tuberosity of type 4b, 4c, and 4d, who met the inclusion criteria and were admitted to the First Affiliated Hospital of Wannan Medical College, Bengbu Third People's Hospital Affiliated to Bengbu Medical University, and Lu'an Hospital Affiliated to Anhui Medical University (hereinafter referred to as the three hospitals) were selected as the control group, including 28 males and 17 females, aged 60 to 78 years. Fifty elderly patients with stage 4 pressure injury in ischial tuberosity of type 4b, 4c, and 4d, who met the inclusion criteria and were admitted to the three hospitals from January 2023 to December 2024 were selected as the observation group, including 31 males and 19 females, aged 60 to 80 years. The stage 4 pressure injury in ischial tuberosity of patients in observation group were classified on admission, and the targeted surgical methods were selected. For type 4b, the fascial flap was preferred for repair, including fascial flap with skin pedicle (12 cases) and kite flap (14 cases); for type 4c, myocutaneous flap repair was preferred (17 cases); for type 4d, island myocutaneous flap (4 cases) or a combination of muscle flap and flaps (3 cases) was preferred for repair. The surgical methods for repairing the pressure injury of patients in control group were selected based on the surgeon's clinical experience. The type 4b was repaired with fascial flap with skin pedicle in 18 cases and kite flap in 6 cases; the type 4c was repaired with fascial flap with skin pedicle in 6 cases, kite flap in 7 cases, and myocutaneous flap in 3 cases; the type 4d was repaired with kite flap in 2 cases and myocutaneous flap in 3 cases. The sizes of wounds in the two groups of patients were 5.5 cm×4.5 cm to 8.0 cm×7.0 cm after the wound bed was prepared, and the sizes of grafted tissue flaps were 5.0 cm×4.5 cm to 10.0 cm×8.0 cm. The wounds in the flap donor sites were directly sutured or repaired with a relay flap. The following data were recorded, including the wound healing rate after one-time surgical repair, wound healing time, length of hospital stay, hospitalization treatment cost, pressure ulcer scale for healing (PUSH) score at discharge, and recurrence rate of pressure injury during follow-up in two groups of patients. Results: The wound healing rate after one-time surgical repair of patients in observation group was 88.00% (44/50), which was significantly higher than 66.67% (30/45) in control group (with relative risk of 1.32, 95% confidence interval of 1.08 to 1.61, χ²=6.48, P<0.05). After adjusting the general information using multiple logistic regression analysis, the wound healing rate after one-time surgical repair of patients in observation group was still significantly higher than that in control group (with relative risk of 1.30, 95% confidence interval of 1.05 to 1.59, χ²=6.14, P<0.05). The wound healing time of patients in observation group was (18±5) d, which was significantly shorter than (27±6) d in control group (with mean difference of -9 d, 95% confidence interval of -12 to -7 d, t=7.73, P<0.05). After adjusting the general information using multivariate covariance analysis, the wound healing time of patients in observation group was still significantly shorter than that in control group (with mean difference of -9 d, 95% confidence interval of -11 to -6 d, F=37.10, P<0.05). The length of hospital stay of patients in observation group was significantly shorter than that in control group (t=5.04, P<0.05), the hospitalization treatment cost was significantly lower than that in control group (t=2.11, P<0.05), and the PUSH score at discharge was significantly lower than that in control group (t=3.08, P<0.05). After a follow-up period of 2 to 24 months after discharge, the recurrence rate of pressure injury of patients in observation group was significantly lower than that in control group (χ²=5.02, P<0.05). Conclusions: Dividing stage 4 pressure injury in ischial tuberosity into multiple subtypes in elderly patients can help guide clinical selection of appropriate repair strategies, increase the wound healing rate after one-time surgical repair, shorten the wound healing time and length of hospital stay, reduce hospitalization treatment cost, and lower the recurrence rate of pressure injury. It is worthy of clinical promotion.