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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Awad SS, Stern JD, Milne CT, Dowling SG, Sotomayor R, Ayello EA, Feo Aguirre LJ, Khalaf BZ, Gould LJ, Desvigne MN, Chaffin AE. Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group. Adv Skin Wound Care 2023; 36:249-258. [PMID: 37079788 PMCID: PMC10144322 DOI: 10.1097/01.asw.0000922708.95424.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2022] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction. METHODS An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds. RESULTS Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention. CONCLUSIONS The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.
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Affiliation(s)
- Samir S Awad
- Samir S. Awad, MD, MPH, FACS, is Professor of Surgery, Baylor College of Medicine and Chief of Surgery, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. James D. Stern, MD, FACS, is Plastic Surgeon, Memorial Regional Hospital, Hollywood, Florida. Cathy T. Milne, APRN, MSN, ANP/ACNS-BC, CWOCN-AP, is Co-owner, Connecticut Clinical Nursing Associates, Bristol, Connecticut. Shane G. Dowling, MSPAS, PA-C, CWS, is Medical Science Liaison, Aroa Biosurgery Limited, Auckland, New Zealand. Ron Sotomayor, BA, RN, CWOCN, is a wound, ostomy, and continence nurse, Advent Health, Orlando, Florida. Elizabeth A. Ayello, PhD, MS, RN, ETN, CWON, FAAN, is Editor-in-Chief, Advances in Skin & Wound Care and President, Ayello, Harris and Associates Incorporated, Copake, New York. Leandro J. Feo Aguirre, MD, FACS, is Colorectal Surgeon, Palm Beach Health Network, Del Ray Beach, Florida. Basil Z. Khalaf, MD, is Wound Care Physician, The MEDIKAL Group, Houston, Texas. Lisa J. Gould, MD, is Plastic Surgeon, South Shore Health, Weymouth, Massachusetts. Michael N. Desvigne, MD, FACS, CWS, is Plastic Surgeon, Desvigne Plastic Surgery and Abrazo Health, Scottsdale, Arizona. Abigail E. Chaffin, MD, FACS, CWSP, is Associate Professor of Surgery and Chief, Division of Plastic Surgery, Tulane University and Medical Director, MedCentris Wound Healing Institute, New Orleans, Louisiana
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Hsu KF, Kao LT, Chu PY, Chen CY, Chou YY, Huang DW, Liu TH, Tsai SL, Wu CW, Hou CC, Wang CH, Dai NT, Chen SG, Tzeng YS. Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon. J Pers Med 2022; 12:jpm12020182. [PMID: 35207670 PMCID: PMC8875003 DOI: 10.3390/jpm12020182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- Kuo-Feng Hsu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114202, Taiwan
| | - Pei-Yi Chu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chun-Yu Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Yu-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Dun-Wei Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Ting-Hsuan Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Sheng-Lin Tsai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chien-Wei Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chih-Chun Hou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
- Correspondence: ; Tel.: +886-2-8792-7195
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Morss-Walton PC, Yi JZ, Gunning ME, McGee JS. Ostomy 101 for dermatologists: Managing peristomal skin diseases. Dermatol Ther 2021; 34:e15069. [PMID: 34309140 DOI: 10.1111/dth.15069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
An estimated 1 million North Americans live with ostomies, with up to 80% of ostomy patients developing stoma-related skin morbidities. While ostomy nurses are often the first line of management, dermatologists may be involved in the care of ostomy patients with complex or persistent peristomal skin complications. Therefore, an understanding of the ostomy apparatus and possible peristomal skin conditions that may arise allows dermatologists to identify skin complications early and work effectively with a multidisciplinary team. In this article, we aim to review the ostomy apparatus, discuss the differential diagnoses, and provide practical guidelines for the management of peristomal skin conditions. Pubmed, Ovid Medline, and Google Scholar were searched for relevant articles assessing peristomal skin complications and their management. Peristomal skin complications may be local (e.g., contact dermatitis, infection, fistula, and mechanical trauma) or secondary to systemic disease (e.g., inflammatory bowel disease, pyoderma gangrenosum, and psoriasis). Ensuring appropriate ostomy fit and proper use of ostomy accessory products helps to reduce effluent leakage and prevent damage to the peristomal skin. For persistent peristomal skin conditions, corticosteroid sprays, systemic therapies, and surgical interventions may be warranted.
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Affiliation(s)
| | - Julie Z Yi
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Mary-Ellen Gunning
- Nursing Wound Ostomy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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