Surgical treatment of pressure ulcers: 20-year experience

Objective: To review the outcomes of surgical management of spinal cord inj ury (SCI) patients with severe pressure ulcers and to examine likely risk f actors for recurrence of pressure ulcers. Design: A retrospective medical record review. Setting: An SCI unit in a tertiary care facility. Patients: All admissions to the SCI unit for grade 4 pressure ulcers from 1 976 to 1996. Intervention: Surgical repair of pressure ulcers. Main Outcome Measure: Complication and recurrence rates of pressure ulcers. Results: Of 598 pressure ulcers, 468 were pelvic area ulcers, of which 431 (92%) were treated surgically. Fifty-three had split-thickness skin graftin g, and 380 were treated with 421 surgical procedures (253 fasciocutaneous o r cutaneous flaps, 93 muscle or musculocutaneous flaps, 75 primary closures ). One hundred,eight (26%) of these procedures required some bone work. Sut ure line dehiscence occurred in 130 (31%), with 45 (11%) requiring reconstr uction and 8 (2%) requiring skin grafting to heal. At discharge, 38 (9%) of these pelvic ulcers had not healed. Recurrent admissions occurred in 90 (5 4%) of the patients. Recurrence of ulcers at the same site occurred in 31% of the total number of ulcers and at a different site in 21%, At the rime o f the 415 admissions, 336 (81%) of the patients were unemployed; 159 (38%) had grade 8 or lower level of education; and 226 (55%) lived alone or with family but were independent in self-care. Of the 168 patients studied, 45 ( 27%) were aboriginal (Canadian native), and 59 (35%) had a history of drug or alcohol abuse. Conclusions: The vast majority of severe pressure ulcers were surgically tr eated. Complication and recurrence rates are similar to previous reports. P sychosocial problems (unemployment, low level of education, drug or alcohol abuse, poverty in the native communities) appear to increase the risk for pressure ulcer development.