The medical and surgical care chain in neuro-injured patients: The experience of the Nantes University Hospital from 2004 to 2014

Abstract

The management of pressure sores in neuro-injured patients at the Nantes University Hospital was organized for 30 years in a medical-surgical care chain. The last ten years of this activity are traced in this retrospective study. All records of patients who had a surgical flap to cover pressure sore between 1 January 2004 and 31 December 2014 were analysed to synthesize results. One hundred and thirteen men and 49 women ( n = 162) were operated of 250 flaps. This was mainly spinal cord injured patients (78%). Patients were divided into two groups: pressure ulcer(s) single or multiple (several lesions operated at the same time or later). There were 67% of ischial lesions, 20% of sacral lesions and 12% trochanteric lesions. The most used flap was that of gluteus maximus (82%) for the ischial and sacral lesions, then comes the tensor fascia lata (12%) for trochanteric lesions. Feature of our series (unlike others [1] ), the hamstring's flap is only used as a last resort (6%) in multirecidivist patients. The complication rate delaying delivery to the chair in theoretical time of six weeks is 35%, to be analysed according to age, general health, the size and number of initial lesions. However, the rate of recurrence after healing of the flap is only 10%. A medical and surgical management, long and sometimes complex [2] , but our long-term results are satisfactory regarding to the low recurrence rate.