Reconstruction Of Pressure Ulcers Research Articles

Comparative Study between Gluteal Artery Perforator Flaps and Local Fasciocutaneous Flaps in Reconstruction of Gluteal Pressure Ulcers.

Gluteal pressure ulcers are a common problem, associated with great morbidity and cost, and their surgical treatment includes debridement with complete bursectomy, followed by soft tissue coverage. Gluteal artery perforator flaps and gluteal fasciocutaneous flaps are commonly preferred for reconstruction because they preserve the gluteal muscle, allowing for revision in recurrent cases. The aim of this study was to evaluate the differences between these two flaps in the reconstruction of gluteal pressure ulcers regarding operative time, postoperative hospital stay, postoperative complications, and recurrence. This prospective comparative study was conducted on 30 patients who presented with stage IV gluteal pressure ulcers. Patients were randomly allocated into two equal groups: each group consisted of 15 patients. Cases in group A were reconstructed using gluteal artery perforator flaps, and those in group B were reconstructed using local fasciocutaneous flaps. There was statistically significant long operative time and short postoperative hospital stay in gluteal artery perforator flaps when compared with local fasciocutaneous flaps. Also, the fasciocutaneous group reported a higher nonsignificant complication rate when compared with the gluteal perforator group. No recurrent cases were reported, and most patients had satisfactory outcomes in both groups. Both techniques are safe, reliable, and effective and can be considered as a first-line option in the reconstruction of gluteal pressure ulcers.

Consistent Reconstruction of Sacrococcygeal Pressure Ulcers using Modification of En Bloc Sliding Gluteus Maximus Myocutaneous Flap Technique

Background: The en bloc sliding gluteus maximus myocutaneous flap was introduced to preserve the vasculature, muscular integrity, sensory innervation, and normal gluteal contour with a midline scar in sacrococcygeal pressure ulcer reconstruction. However, its critical disadvantages include incomplete detachment of the origin of the gluteus maximus and central tension of the closed wound due to round ulcer excision. Therefore, we reviewed the surgical anatomy and applied modifications to achieve sufficient flap mobilization and to decrease complications.Methods: After fusiform or rocket-shaped ulcer excision, submuscular flap elevation was initiated by completely detaching the origin of the gluteus maximus, including the posterior iliac crest, followed by comprehensive lateral submuscular dissection in the gluteal space while preserving the neurovascular pedicles. Bony protrusions were tangentially resected from the lower sacrum and upper coccyx. After en bloc medial advancement of the bilateral flaps, defects were closed in layers, with muscle ligament fixation at the midline.Results: Twenty-nine patients underwent surgery for sacrococcygeal pressure ulcers (primary, n=22; recurrent, n=7). Transverse width of the excised ulcers was 5–12 cm (final defect, 7–15 cm). During the follow-up period (6 months to 7 years), no early postoperative complications or late aesthetic or functional discomfort occurred; however, intermittent skin sloughing occurred in four cases and one coccygeal sore recurrence occurred. The recurrent ulcer was treated using the same surgical method, with no recurrence after 2 years.Conclusion: This modification can be successfully used for the reconstruction of primary and recurrent sacrococcygeal pressure ulcers.

Risk factors for pressure ulcer recurrence following surgical reconstruction: A cross-sectional retrospective analysis.

Many studies on the recurrence of pressure ulcers after surgical reconstruction have focused on surgical techniques and socioeconomic factors. Herein, we aimed to identify the risk factors of the associated comorbidities for pressure ulcer recurrence. We enrolled 147 patients who underwent pressure ulcer reconstruction and were followed up for more than three years. The recurrence of pressure ulcers was defined as recurrent pressure ulcers with stage 3/4 pressure ulcers. We reviewed and analyzed systematic records of medical histories, including sex, age, associated comorbidities such as spinal cord injury (SCI), diabetes mellitus (DM), coronary artery disease, cerebral vascular accident, end-stage renal disease, scoliosis, dementia, Parkinson's disease, psychosis, autoimmune diseases, hip surgery, and locations of the primary pressure ulcer. Patients with recurrent pressure ulcers were younger than those without. Patients with SCI and scoliosis had higher odds, while those with Parkinson's disease had lower odds of recurrence of pressure ulcers than those without these comorbidities. Moreover, the decision tree algorithm identified that SCI, DM, and age < 34 years could be risk factor classifiers for predicting recurrent pressure ulcers. This study demonstrated that age and SCI are the two most important risk factors associated with recurrent pressure ulcers following surgical reconstruction.

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

Evaluation of Gluteal Artery Perforator Flaps in Reconstruction of Gluteal Pressure (Decubitus) Ulcers

The versatility of tensor fascia lata allografts for soft tissue reconstruction.

The purpose of this retrospective study was to introduce our successful use of tensor fascia lata allograft to reconstruct various soft tissue defects. Since May 2021, we have applied tensor fascia lata allografts in eight cases. A frozen type of fascia of 0.6 mm thickness was used in all cases, and allografts were covered by vascularized soft tissue. We used tensor fascia lata allograft in eight cases to cover the infected wounds, donor site closure, and pedicle protections. These were abdominal wall and back reconstructions following rectus muscle and latissimus dorsi muscle harvest, coverage of infected spine wound after posterior fusion, pressure ulcer reconstruction, and pedicle protection of free and pedicle flaps. The follow-up periods were from one to 14 months. None of the cases showed wound problems after initial reconstruction using tensor fascia lata allografts. Tensor fascia lata allograft could be an excellent cost-effective surgical option comparable to autologous tissue grafts. Level of evidence: IV.

598 Reconstruction of Trochanteric Pressure Ulcers with Pedicled Vastus Lateralis-Anterolateral Thigh Flap

IntroductionTrochanteric region is one of the most frequent site for pressure ulcer development. High-voltage electric injuries with neurovascular damage is an important reason of paraplegia. These patients have prolonged hospitalization period and develop cachexia by time. Grade 3-4 sores with thoracanter major of femur exposition generally need flap reconstruction. Musculocutaneous flaps are preferred to cover exposed bone and fill the dead space. Although loco regional flaps such as tensor fasia lata, gluteus Maximus muscle flap have been used for thoracanteric ulcers, these flaps have mandatory muscles for ambulation in the following rehabilitation period. Another disadvantage of these flaps are the possible donor site problems due to pressure loading. Thus, we aimed to used vastus lateralis- anterolateral thigh(VL-ALT) flap for decreasing donor-site morbidity and tension.MethodsBetween 2019 and 2021 we have operated 6 trochanteric pressure ulcers in 5 patients. All patients had history of electric injury related paraplegia. The mean age of the patients was 33 (24-50) The defect size were ranging between 5x4cm and 10x12 cm. Flap size were planned according to exact size of the defect. VL muscle were harvested according to the size of dead space. The donor site was closed primarily in 3 patients. Split thickness skin graft were needed in 2 patients. Patients were hospitalized in lateral decubitus or supine position during follow –up.ResultsMean follow up time was 10 months (6-18). All flaps were survived. Hematoma development were seen in 1 patient in the donor site which were treated with bedside debridement. No recurrence was seen during follow-up period. No restriction or morbidity were encountered during ambulation.ConclusionsVL-ALT musculocutaneous flap provides the required tissue for dead space filling and defect closing simultaneously. The advantages of this flap are; lower donor site morbidity, perfect match in terms of skin quality and bulk, protecting the major muscles such as gluteus maximus and tensor fascia lata. The technique needs knowledge of quadratus femoris anatomy which has a short learning curve.

Treatment for a Post-Reconstruction Seroma Using Viscum album Extract in a Patient with a Pressure Ulcer: A Case Series

Seromas commonly occur or recur after reconstructive surgery in patients with pressure ulcers, often leading to infection, increasing the risk of wound dehiscence and flap necrosis, and therefore requiring an additional surgical procedure. Various strategies have been employed to treat seroma, such as retaining as much of the fascia as possible, using progressive tension sutures, inserting suction drains, utilizing sclerotherapy, or applying compression via dressings or specialized garments. However, despite these efforts, seroma prevention remains difficult. In the current report, we describe three cases in which we administered Viscum album extract to prevent and treat seromas that developed following pressure ulcer reconstruction. V. album extract sclerotherapy was performed in a patient with a recurrent seroma, a patient with a persistent seroma, and a patient wishing to undergo sclerotherapy immediately postoperatively as a prophylactic treatment. The seromas resolved shortly after initiating treatment, and recurrence was not observed at any of the subsequent outpatient follow-up visits. These cases suggest that sclerotherapy with V. album extract following pressure ulcer reconstruction can suppress development of seromas and lower the risk of recurrence.

Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)-Experience of a Single Surgeon.

Background: In this study, we aimed to analyze the clinical efficacy of closed-incision negative pressure wound therapy (CiNPWT) when combined with primary closure (PC) in a patient with pressure ulcers, based on one single surgeon’s experience at our medical center. Methods: We retrospectively reviewed the data of patients with stage III or IV pressure ulcers who underwent reconstruction surgery. Patient characteristics, including age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, application of CiNPWT to reconstructed wounds, duration of hospital stay, and wound complications were analyzed. Results: Operation time (38.16 ± 14.02 vs. 84.73 ± 48.55 min) and duration of hospitalization (36.78 ± 26.92 vs. 56.70 ± 58.43 days) were shorter in the PC + CiNPWT group than in the traditional group. The frequency of debridement (2.13 ± 0.98 vs. 2.76 ± 2.20 times) was also lower in the PC + CiNPWT group than in the traditional group. The average reconstructed wound size did not significantly differ between the groups (63.47 ± 42.70 vs. 62.85 ± 49.94 cm2), and there were no significant differences in wound healing (81.25% vs. 75.38%), minor complications (18.75% vs. 21.54%), major complications (0% vs. 3.85%), or mortality (6.25% vs. 10.00%) between the groups. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable.

Augmented flap reconstruction of complex pressure ulcers using synthetic hybrid-scale fiber matrix.

Flap reconstruction of pressure ulcers offers an important clinical means of decreasing morbidity in hospitalized patients. A new, novel method of managing pressure ulcer wounds uses a synthetic hybrid-scale fiber matrix prior to tissue flap reconstruction. This synthetic hybrid-scale fiber matrix is comprised of micron-scale and nanoscale fiber structure similar to that of human extracellular matrix and supports cell ingrowth, retention, and granulation tissue formation. The primary objective of the present study was to examine use of the synthetic hybrid-scale fiber matrix as a means of encouraging granulation tissue within complex wounds to promote successful and lasting wound closure following flap reconstruction. Patients included in this retrospective study had pressure ulcers that were not successfully managed with other wound therapies; in addition, these patients presented with various risk factors for postoperative complications. Before treatment, sharp debridement of the wound margins and wound bed was performed. Wounds were subsequently treated by applying synthetic hybrid-scale fiber matrix prior to flap reconstruction, based on physician assessment of wound status. The primary objective to include the synthetic hybrid-scale fiber matrix in the treatment approach of pressure ulcers in this case series was to ensure (1) integration to the wound bed prior to flap closure to encourage granulation tissue formation at a later time and (2) lasting successful wound closure following flap reconstruction. Overall, the patient outcomes indicated that the synthetic hybrid-scale fiber matrix was used to manage pressure ulcers successfully, with a wound closure rate of 90.9% (10 cases of complete wound closure and 1 case of 97.2% wound area reduction). Additionally, no complication related to the application of each synthetic hybrid-scale fiber matrix was reported. Application of synthetic hybrid-scale fiber matrix to the wound bed prior to flap closure promotes cellular ingrowth and granulation tissue formation, which promotes successful and lasting wound closure following flap reconstruction.

Best Solutions for Perineal and Pressure Sore Reconstruction.

After studying this article, the participant should be able to: 1. Understand variations of the myocutaneous rectus abdominis muscle flap as it is used for perineal reconstruction and discuss common and alternative options for perineal defect reconstruction. 2. Review primary options and alternatives to pressure sore reconstruction if the primary option is not available and recognize when pressure sore reconstruction is not feasible. 3. Highlight pertinent anatomy and techniques for the flaps described. Perineal reconstruction following tumor resection is often complicated by irradiated tissue and multiple comorbidities, making reconstruction challenging. Management of these conditions can have complication rates as high as 66 percent, which further compounds the costs and implications of managing these wounds. These complication rates can be significantly decreased using flap closure rather than primary closure. Pressure ulcers also occur in patients with poor overall health, multiple comorbidities, and often numerous prior failed reconstruction attempts. Comprehensive management of pressure sores is a significant burden to the health care system, at a cost of $9.1 to $11.6 billion per year. There exists an extensive body of literature describing the pathophysiology and management strategies for these problems. The focus of this article is to discuss best solutions for perineal and pressure ulcer reconstruction, and to explore alternative options for reconstruction.

Reconstruction of recalcitrant pressure ulcers with latissimus dorsi muscle-splitting free flaps.

Reconstruction of recalcitrant pressure ulcers is very challenging because all available local tissues have been exhausted. Although occasionally suggested as reconstructive options in some reports, free flaps are still not favored for pressure ulcers because of the less available recipient vessels in buttock area and the need for position change. Here, we describe our experience with latissimus dorsi muscle-splitting free flaps harvested in prone position for recalcitrant pressure ulcers. Between January 2012 and January 2020, 10 patients of recalcitrant pressure ulcers underwent reconstruction using latissimus dorsi muscle-splitting free flaps. To harvest flaps in the prone position, the curvilinear incision was made along the line connecting the lateral border of the scapula and the midaxillary line of the armpit and the latissimus dorsi muscle was split just below the skin incision. Only the required amount of muscle was harvested including the 5 × 3cm sized muscle cuff around bifurcation points of the transverse and descending branches. Flap size ranged from 16 × 9 to 24 × 14 cm and the gluteal vessels were mainly used as recipients. The mean operation time was 170 mins. All the flaps survived but two patients suffered wound disruption and partial flap loss, respectively. During the mean follow-up periods of 2.45 years, there were no recurrences at the reconstruction site, and no patient complained of donor site morbidity. Based on the results obtained from this consecutive series of patients, latissimus dorsi muscle-splitting free flaps are valuable option for recalcitrant pressure ulcer reconstruction.

Reading Man Flap for Sacral Pressure Ulcer Reconstruction

Background: The treatment of pressure sores represents a great challenge to health care professionals.Although, pressure ulcers management requires a multidisciplinary approach, the soft tissue defects requiringreconstruction are mainly considered for surgical repair. Local myocutaneous and fasciocutaneous flaps canprovide stable coverage of pressure sores.Aim of Study: To evaluate the versatility and outcomes of “reading man flap” in the reconstruction of sacralpressure sores.Patients and Method: Between April 2015 to January 2017, ten patients with sacral pressure sore weretreated by using Reading man flap. The patient’s ages were ranging between 35-65 years (mean 53), 6 ofthem were males, and 4 were females. All of them were subjected to local wound care and managementwithout considerable benefit. We exclude those patients with poor medical status and patients with severecontracture and spasticity. The diameter of the sacral pressure sores ranging from 4cm to 7cm (mean 5.5cm).Results: The “reading man flap” technique was seen to be a useful, versatile and simple flap for coverageof pressure sores, with no postoperative complications in 8 of our patients during the follow up period. Theother 2 patients, one of them developed partial flap necrosis (treated conservatively), and the other onedeveloped recurrence after 2 months.Conclusion: The “reading man flap” was found to be a versatile and easily performed technique for closureof small to medium sized sacral pressure sores.

Reconstruction of pressure ulcers with flaps in a tertiary care centre

Background: Patients with pressure ulcers have multiple risk factors and develop various post- operative complications. The purpose of the study is to analyse the outcome of management of pressure ulcers with different flaps.Methods: This is a retrospective study done in a series of patients who underwent flap reconstruction of pressure ulcers between 2016 and 2019 in the Department of Plastic and Reconstructive Surgery, Thanjavur medical college, Tamilnadu, India. Totally twenty-eight patients were operated for stage III and stage IV pressure ulcers with various types of flaps depending upon the site of pressure ulcers. Post operatively flaps were monitored for viability and post-operative complications. Results: Total 22 males, 5 females and 1 male child had undergone surgery for pressure ulcers. The age group ranged from 3years to 62 years with an average of 37 years. The sites of the pressure ulcers were as follows: 14 (50%) sacral; 10 (35.7%) ischial; 3 (10.7%) trochanteric and 1 (3.6%) multiple pressure ulcers. Most of the patients (60.7%) had traumatic paraplegia and developed pressure ulcers. 18 patients with stage III and 10 patients with stage IV pressure sores were operated with different flaps. Duration of treatment ranged from 29 to 118 days. The mean hospitalization was 78 days. Conclusions: Effort is needed to prevent the development of pressure ulcers through the early identification of risk and early implementation of preventive measures. Flap cover is ideal to prevent recurrence. Post-operative follow- up with physiotherapy and rehabilitation are very important.

Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

Clostridium difficile Infection in the Plastic Surgery Population: Lessons from the ACS NSQIP Database.

Background:Clostridium difficile–associated infections (CDI) have a significant impact on morbidity and mortality of hospitalized medical and surgical patients. There is a paucity of data regarding the incidence, impact, and modifiable risk factors in the plastic surgery population.Methods:The ACS NSQIP database was retrospectively queried for all cases performed by plastic surgeons during 2016. All plastic surgery cases, combined cases, demographics, and baseline clinical characteristics were extracted from the database. The study population was divided into 2 groups based on the development of CDI. Independent variables for development of CDI were identified.Results:During the study period, a total of 29,256 patients underwent a procedure by plastic surgery, with the most commonly performed procedures involving the breast (58%) and trunk (14%). Only 44 patients developed post-operative CDI (0.1%). Factors independently associated with development of CDI were wound classification at the end of the surgery, COPD, procedures involving the trunk, and surgery for reconstruction of pressure ulcers. Outpatient surgery was associated with decreased odds of developing CDI [AOR (95% CI):0.2 (0.1, 0.4), adj P < 0.001]. Staying overnight did not increase the odds of developing CDI; however, staying for >1 day in the hospital was associated with an increased risk of CDI development [AOR (95% CI): 1.03 (1.01, 1.13), adj P = 0.001]. Combined cases, ASA, body mass index, diabetes, and active smoking were not associated with CDI.Conclusions:CDI are rare in the plastic surgery population and are most associated with trunk/decubitus ulcer reconstructions, inpatient hospital stay, and contaminated wounds. The patients that usually fit in these categories have acutely or chronically infected wounds, which are often treated with systemic antibiotics. For patient with decubitus ulcers and other trunk reconstruction, the guidelines for pre and post-operative systemic antibiotic usage is not well defined. For patients who have had trunk reconstruction, development of evidence-based antibiotic stewardship guidelines may help these patients by limiting antibiotic usage and thereby reducing the incidence of CDI.

Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach?

IntroductionThere are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. ObjectiveThe aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. MethodA retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. ResultsThe primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant.Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total.We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. ConclusionsThere are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery.The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.

Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores

Ischial sores have higher risks of recurrence and considered the most difficult to treat. There are mainly 2 groups of techniques used in ischial pressure sore reconstruction which are as follows: (1) fasciocutaneous and/or myocutaneous flaps (Fc/Mc) and (2) perforator flaps. The aim of this study is to determine the advantages of perforator flaps over Fc and/or Mc flaps in reconstruction of ischial pressure ulcers. All articles published before April 2018 were investigated and searched for eligibility using the databases PubMed and Google Scholar. Eligible studies were determined according to inclusion and exclusion criteria. Recurrence rates, complication rates, and time of recurrences were assessed. A total of 15 studies with 279 patients and 305 flaps were identified and included in the final analysis. The overall recurrence rate of flaps was 6.31 (95% CI, 5.86 to 6.78; p 0.05), complication rates (p > 0.05), and time of recurrences (p > 0.05). Perforator flaps mandate thorough pre-operative preparations, meticulous dissections, and long surgery times. There seem no advantage in applying perforator flaps in ischial pressure sore reconstructions in terms of complications and recurrences. Surgeons may prefer to perform straightforward procedures, such as myocutaneous flaps. Level of evidence: Level IV, risk/prognostic, therapeutic study.

A dual padding method for ischial pressure sore reconstruction with an inferior gluteal artery perforator fasciocutaneous flap and a split inferior gluteus maximus muscle flap.

BackgroundVarious surgical management methods have been proposed for ischial sore reconstruction, yet it has the highest recurrence rate of all pressure ulcer types. A novel approach combining the advantages of a perforator-based fasciocutaneous flap and a muscle flap is expected to resolve the disadvantages of previously introduced surgical methods.MethodsFifteen patients with ischial pressure ulcers with chronic osteomyelitis or bursitis, who underwent reconstructive procedures with an inferior gluteal artery perforator (IGAP) fasciocutaneous flap and a split inferior gluteus maximus muscle flap from January 2011 to June 2016, were analyzed retrospectively. The split muscle flap was rotated to obliterate the deep ischial defect, managing the osteomyelitis or bursitis, and the IGAP fasciocutaneous flap was rotated or advanced to cover the superficial layer. The patients’ age, sex, presence of bursitis or osteomyelitis, surgical details, complications, follow-up period, and ischial sore recurrence were reviewed.ResultsAll ischial pressure ulcers were successfully reconstructed without any flap loss. The mean duration of follow-up was 12.9 months (range, 3–35 months). Of 15 patients, one had a recurrent ulcer 10 months postoperatively, which was repaired by re-advancing the previously elevated fasciocutaneous flap.ConclusionsThe dual-flap procedure with an IGAP fasciocutaneous flap and split inferior gluteus maximus muscle flap for ischial pressure ulcer reconstruction is a useful method that combines the useful characteristics of perforator and muscle flaps, providing thick dual padding with sufficient vascularization while minimizing donor morbidity and vascular pedicle injury.

Evaluation of Therapeutic Outcomes of Reconstruction of Pressure Ulcer Injuries by Flap Coatings in Patients Admitted to Taleghani Hospital in Kermanshah during 2015-2016

Objective: Pressure ulcers, following cancer and heart disease, are considered as the third most costly health problem. In addition to high cost of treatments, considerable time is spent on care for patients. This study tends to evaluate the therapeutic outcomes of reconstruction of pressure ulcer injuries by flap coatings.&#x0D; Methods: This study is prospective; 85 patients with pressure ulcer who referred to Taleghani Hospital in Kermanshah during 2015-2016 for treatment by muscular coating flaps were followed up 1 week and 3 months after discharge. A questionnaire based on main objectives of the project including demographic information, treatment complications, treatment outcome, reconstruction, number of flaps to assess the success of flap coating in patients was completed for each patient. Considering the 95% confidence level and the 9% accuracy, treatment success rate was 76%, with a minimum sample size of 85 in each group. Reconstruction was done again if the treatment was unsuccessful. Data was analyzed by SPSS software version 22.&#x0D; Results: The success rate of pressure ulcer reconstruction by coating flaps significantly increased after 1 week and 3 months (P&lt;0.05, 50.6% and 90.5%, respectively). The success rate of pressure ulcer reconstruction by coating flaps significantly increased after 1 week and 3 months in terms of age, gender, and BMI (P&lt;0.05).&#x0D; Conclusion: The success of pressure ulcer reconstruction increased by coating flaps after 3 months. Therefore, it is suggested that further studies be developed in the future. Second, this study did not have control group. Therefore, it is recommended to consider this in future studies.

The Modified Keystone Flap for Pressure Ulcers: A Modification of the Keystone Flap With Rotation and Advancement.

The reconstruction of extensive soft tissue defects from pressure ulcers is a great challenge. Resurfacing such defects with like tissues and minimizing morbidities are important. Here we present our surgical experience using a novel modified keystone flap for pressure ulcer patients. We retrospectively reviewed the data of 13 consecutive cases reconstructed with the modified keystone flaps between March and December, 2017. The mean dimensions of the reconstructed defect were 7.7 × 6.5 cm, while the mean dimensions of the flap were 12.1 × 8.3 cm. Time efficient reconstructions with the modified keystone flap were performed without any following major complications. Minor wound dehiscence occurred in only one case, which soon healed with conservative management. Considering its simple design, reliable flap survival, minimal donor-site morbidity, optimal flap thickness, and evenly distributed surgical tension, our novel technique of the modified keystone flap is as an excellent surgical option for the reconstruction of pressure ulcers in the gluteal region.