Results evaluation of the modern surgical treatment methods for pressure ulsers in patients with the spinal cord injuries consequences

Abstract

The aim — to evaluate the effectiveness of modern preoperative methods for pressure ulcers in patients with the spinal cord injuries consequences.Materials and methods. A comparative analysis of 178 patients’ records with the spinal cord injuries consequences, which were complicated by bedsores in the rehabilitation period of the traumatic disease was carried out. The patients were divided into three groups, depending on the method of preoperative preparation. Mud therapy and ozonotherapy were used in the first group (n = 76), ultrasonic­assisted wound debridement and VAC­therapy were applied in the second group (n = 44). Preoperative preparation was performed with ointment dressings, wound dressings and antiseptic solutions in the comparison group (n = 58). Closure of soft tissue defects was performed by the method of autodermoplasty, local plastics or displaced grafts.Results and discussion. The regularity of the pressure ulcers appearance was determined according to the level of damage. In patients with cervical injuries, pressure ulcers were localized in the sacral region at 48.9 %, in cases of thoracic and lumbar levels of injuries, localization in the ischial area (32.1 %) prevailed. The use of ozonotherapy and peloidotherapy in the first group, ultrasonic­assisted wound debridement and VAC­therapy in the second group reduced the preoperative period to 12.1 ± 1.1 and 10.4 ± 0.9 days, respectively. Them the routine methods were applied, the pressure ulcers were ready for plasty by 15.9 ± 1.4 day. Auto­skin­grafting was used in 11 (6.2 %) patients, local flaps in 46 (25.9 %), regional flaps in 121 (67.9 %) cases. The early postoperative period was complicated by suppuration in 19.1 %, wound breakdowns in 10.7 %, and the marginal necrosis of the flap in 10.1 %. In the second group, the smallest proportion of early complications was observed due to a decrease in the number of wound breakdowns to 4.5 % and suppurations to 11.4 %.Conclusions. VAC­therapy and ultrasonic­assisted wound debridement allows for a short period of time to achieve the readiness of tissues among pressure ulcers for the plastic surgery. The optimal method for closing pressure ulcers is the plastic with distant axial muscle flaps, combined with anatomically­functional resection of the subordinate bones.