Pc. Kierney et al., RESULTS OF 268 PRESSURE SORES IN 158 PATIENTS MANAGED JOINTLY BY PLASTIC-SURGERY AND REHABILITATION-MEDICINE, Plastic and reconstructive surgery, 102(3), 1998, pp. 765-772
Despite improvements in surgical repair of pressure sores, recurrence
rates greater than 80 percent are reported, thus indicating that this
difficult problem is not yet solved. Recurrence results in additional
hospitalizations and increased medical expenses. Because associated ge
neral clinical and social issues are numerous for these patients, our
physical medicine and rehabilitation colleagues are active participant
s in their perioperative medical care. In addition, the Department of
Physical Medicine and Rehabilitation also directs a complete postrecon
struction rehabilitation and education program for them. The results o
f surgically repaired pressure sores for patients managed in this coll
aborative fashion have not been previously reported. Pressure sore pat
ients at the Harborview and University of Washington Medical Centers a
re evaluated by plastic surgery colleagues together with the Departmen
t of Physical Medicine and Rehabilitation. Patients believed to be can
didates for complete postoperative rehabilitation are offered surgical
repair and constitute this study cohort. Individuals who cannot coope
rate with our protocol are treated nonoperatively and are not included
in this study. A retrospective analysis of all 158 patients (mean age
34.5 years) operated on for 268 grade III and IV pressure sores betwe
en October of 1977 and December of 1989 was performed. Following surgi
cal debridement and reconstruction, patients receive their principal m
edical care from the Department of Physical Medicine and Rehabilitatio
n sen,ice while the Plastic Surgery Department manages the surgical wo
unds. Graduated patient mobilization is initiated in accord with a mut
ually agreed upon standardized protocol. New or primary sores numbered
174 (65 percent), and recurrent or secondary sores numbered 94 (35 pe
rcent). Mean patient follow-up was 3.7 years. The overall pressure sor
e recurrence rate (recurrence at the same site) was 19 percent, and th
e overall patient recurrence rate (previous patient developing a new s
ore) was 25 percent. Recurrence rates of 22 and 15 percent were noted
for primary and secondary pressure sores, respectively. On most recent
examination, 131 patients (83 percent) had intact pelvic and perineal
skin. These results support a collaborative approach to the managemen
t of high-grade pressure sore patients. Our protocol of mutual patient
evaluation followed by surgical reconstruction and postoperative reha
bilitation yields notably low recurrence rates of both primary and sec
ondary sores. In addition, the high percentage of patients who manifes
t long-term maintenance of skin integrity demonstrates the excellent e
ducation in personal skin and self-care that this approach provides. N
ot only do patients enjoy successful and durable reconstructive result
s, but additional hospitalizations and health care expenses implicit t
o pressure sore recurrence are consequently di minished. This collabor
ative clinical effort remains our standard of care.