Abstract
Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
Highlights
A pressure injury (PI) is defined as localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to medical or other devices.[1]In 2016, the National Pressure Ulcer Advisory Panel (NPUAP).[1] suggested that the term injury be used instead of ulcer and that the stages be denoted using Arabic rather than Roman numerals
The NPUAP's staging system that describes the extent of tissue loss and the physical appearance of the injury caused by pressure and/or shear, progressing from Stages 1–4, has been widely adopted internationally and has become the basis for treatment and comparison of outcomes
But the most important role is played by medical conditions that cause reduced mobility or require the need for medical devices, that are responsible for PIs in 38.5%–90% of paediatric cases
Summary
A pressure injury (PI) is defined as localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to medical or other devices.[1]. PIs can be painful, can be complicated by infection, impact negatively on the quality of life, and heal with difficulty, despite the availability of many therapies and preventive measures, none of which has been demonstrated to be superior to the others.[2] They are more frequent in the adult, and especially in the geriatric population, pressure injuries can develop in children.[3]. But the most important role is played by medical conditions that cause reduced mobility or require the need for medical devices, that are responsible for PIs in 38.5%–90% of paediatric cases Patients with this type of PI tend to be younger.[4,5]. Reliable numbers on the prevalence of PIs in children can be found, among others, in a large study including 39,984 patients 1 day to 18 years old treated in 678 paediatric acute care units of 271 US hospitals.
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