A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure

Understanding recurrent pressure injuries: A scoping review of current research and risk factors

AIM

To describe published studies on the current status of recurrent pressure injuries.

BACKGROUND

Pressure injuries burden patients and the health care system, so it is essential to prevent their recurrence and prevent patients from experiencing secondary injury. However, most current studies focus on primary pressure injury and less on its recurrence.

DESIGN AND METHODS

We employed a scoping review methodology. From the database construction until December 9, 2024, we searched PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library. Two researchers independently screened and extracted data.

RESULTS

Twenty-eight articles met our criteria, most published after 2000. The included studies showed that 13 articles dealt with the definition of recurrent pressure injuries, but no uniform standard has been formed yet. The incidence of recurrent pressure injuries is 5.4 %-73.6 %. The most commonly reported site of recurrence is the ischium. The high-risk population for recurrence is the patient with spinal cord injury. Eleven studies described 26 risk factors for recurrent pressure injuries, of which albumin was the most commonly reported risk factor, followed by spinal cord injuries, age, hospital stay, and ulcer size. The 26 risk factors were summarised into five aspects: personal factors, social-environmental factors, disease-related factors, physiological and biochemical parameters, and Initial ulcer characteristics.

CONCLUSIONS

The incidence of recurrent pressure injuries varies widely, and specific definitions and standardised staging criteria must be further determined to improve clinical judgment and reporting accuracy. The risk factors for recurrent pressure injuries involve many aspects. Some studies have described local flaps and overall recurrence risk factors separately, and further verification is needed to determine whether there is a difference between the two.

A Guide to Perforator Flap Selection for Buttock Pressure Sore Reconstruction

ABSTRACT

Perforator flaps have been increasingly used to repair stage IV buttock pressure ulcers. However, no one has proposed an approach for stage IV buttock pressure ulcers repairing based on the subregion of buttock pressure ulcers. This study aims to evaluate the effect of perforator flaps in the repair of stage IV buttock pressure ulcers, and flap selection was based on the location of the pressure ulcers. Over the past 5 years, we evaluated 65 cases of stage IV buttock pressure ulcers repaired using perforator flaps. Flap selection was based on the subregion of each buttock pressure ulcer, following our approach. A total of 87 perforator flaps were used for 65 cases, including 42 superior gluteal artery perforator flaps, 19 fourth lumbar artery perforator flaps, and 26 descending inferior gluteal artery perforator flaps. All patients showed satisfactory reconstruction. The authors' approach can support surgeons in selecting the appropriate flaps to repair stage IV buttock pressure ulcers and achieve excellent reconstructive outcomes. This method makes the selection of flaps for pressure ulcer repair systematic, simple, and highly feasible and thus is worthy of promotion.

Measurement of combined flap thickness for reconstruction of decubitus ulcer using computed tomography

BACKGROUND

Various reconstruction options have been introduced to treat decubitus ulcers. A combined flap that takes advantage of the fasciocutaneous and muscle flaps has been proven to be effective in reconstructing decubitus ulcers in previous studies. However, no studies have measured combined flap thickness. This is the first study to demonstrate the superiority of the combined flap by measuring its thickness using enhanced abdominopelvic computed tomography (APCT).

AIM

To evaluate combined flap modality as a useful reconstruction option for decubitus ulcers using measurements obtained through APCT.

METHODS

Fifteen patients with paraplegia who underwent combined flap surgery for reconstruction of decubitus ulcers between March 2020 and December 2021 were included. The defects in the skin and muscle components were reconstructed separately. The inner gluteus muscle flap was split and manipulated to obliterate dead space. The outer fasciocutaneous flap was transposed to cover the muscle flap and opening of the decubitus ulcer. Subsequently, we performed enhanced APCT at 3 wk and 6 mo postoperatively to measure the flap thickness.

RESULTS

The mean flap thickness was 32.85 ± 8.89 mm at 3 wk postoperatively and 29.27 ± 8.22 mm at 6 mo postoperatively. The flap thickness was maintained without any major complications such as contour deformities or recurrence.

CONCLUSION

Although there was a significant decrease in flap thickness as measured by APCT, the combined flap provided sufficient padding and maintained its thickness even at 6 mo after reconstruction, suggesting that the combined flap modality may be a useful reconstruction option for patients with paraplegic decubitus ulcers.

Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND

Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries, which may represent a serious threat to patients' life and health. An effective nursing program should be adopted for timely intervention in patients with pressure wounds.

AIM

To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.

METHODS

Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method. The control group was treated with conventional nursing care (CNC), and the study group was treated with care services based on multidisciplinary collaborative care (MDCC). The Pressure Ulcer Scale for Healing (PUSH), healing effect, Self-Perceived Burden Score (SPBS), and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.

RESULTS

Sixty-two patients were enrolled, and 31 patients were assigned to each group. The results of the interventions were as follows: (1) There was no significant difference between the PUSH scores of the MDCC group (11.19 ± 2.46) and CNC group (12.01 ± 2.79) before the intervention (P > 0.05), and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group (6.63 ± 1.97 and 3.11 ± 1.04) than in the CNC group (8.78 ± 2.13 and 4.96 ± 1.35 points) (P < 0.05); (2) The rate of wound healing in the MDCC group (96.77%) was higher than that in the CNC group (80.65%) (P < 0.05); (3) There was no significant difference between the SPBS scores of emotional factors (21.15 ± 3.11), economic factors (9.88 ± 2.15), and physical factors (8.19 ± 2.23) in the two groups before the intervention. The scores of emotional factors (13.51 ± 1.88), economic factors (6.38 ± 1.44), and physical factors (5.37 ± 1.08) were lower in the MDCC group than in the CNC group (16.89 ± 2.05, 7.99 ± 1.68 and 7.06 ± 1.19) after 4 wk of intervention (P < 0.05); and (4) Satisfaction with the intervention was higher in the MDCC group (93.55%) than in the CNC group (74.19%) (P < 0.05).

CONCLUSION

Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients' self-perceived burden, improve pressure wound conditions, facilitate wound healing, and increase patient satisfaction with the intervention.

Best Solutions for Perineal and Pressure Sore Reconstruction

LEARNING OBJECTIVES

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.

SUMMARY

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.

Volumetric Evaluation of Dead Space in Ischial Pressure Injuries Using Magnetic Resonance Imaging: A Case Series

OBJECTIVE

To establish a preoperative evaluation procedure by measuring the volume of dead space using MRI in patients with ischial pressure injuries.

METHODS

Patients with spinal cord injury and ischial pressure injuries who underwent treatment between August 2016 and November 2019 were included in the study. Preoperative MRI scan was conducted on all patients. The volume estimation and three-dimensional (3D) reconstruction were performed based on MRI data using a 3D Slicer. Based on the resulting volume, a muscle flap that could fit the dead space was selected. Surgery was performed with the selected muscle flap, and a fasciocutaneous flap was added, if necessary.

RESULTS

A total of eight patients with ischial pressure injuries were included in the study. The mean patient age was 59.0 ± 11.0 years. The mean body mass index was 26.62 ± 3.89 kg/m2. The mean volume of dead space was 104.75 ± 81.05 cm3. The gracilis muscle was the most selected muscle flap and was used in four patients. In five of eight cases, a fasciocutaneous flap was used as well. The mean follow-up period was 16 months, and by that point, none of the patients evinced complications that required surgery.

CONCLUSIONS

To the authors' knowledge, this is the first report on volumetric evaluation of dead space in ischial pressure injuries. The authors believe that the 3D reconstruction process would enable adequate dead space obliteration in ischial pressure injuries. The authors propose that preoperative MRI scans in patients with ischial pressure injury should become an essential part of the process.

Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores-A New Design

Background  “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator.

Aim and Methods  After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same.

Results  Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group ( p < 0.045), and in only 3 patients of the control group.

Conclusions  This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.