Pressure sores as a complication in patients with spinal cord injury. Prevention and treatment
Keywords:
Pressure Sores, Spinal Cord Injury, FlapReconstruction, Pressure Sores’Treatment
Abstract
The present study critically examined pressure sores/ulcers as a seminal side effect associated with patients who have suffered spinal cord injury. The statistics show that a large percentage of this patient group develops pressure sores due to prolonged bedrest and inactivity. The aim of this study was to present a review of pressure sores treatment tactics that specifically pertain to patients who remain immobile due to spinal cord injury. The available methods for prevention and treatment of pressure sores either conservatively or surgically were assessed. Source material for this review was chosen according to its specificity to pressure ulcers and spinal cord injury. The choice of treatment is decided according to the categorization of pressure sores into 4 stages. The study focused on surgical treatment via the use of flaps, that has been shown to be revolutionary in handling advanced pressure ulcers (stage III and IV), yielding a large percentage of successful operations. The surgical intervention was then extensively analysed in terms of operative procedure, postoperative management andpossible complications. In conclusion, flap reconstruction was found to be successful in optimizing the treatment of pressure ulcers in patients with spinal cord injury.
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References
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7. Cooper L, Vellodi C, Stansby G, Avital L. The prevention and management of pressure ulcers: summary of updated NICE guidance. J Wound Care. 2015;24(4):179-184. doi:10.12968/jowc.2015.24.4.179
8. Tew C, Hettrick H, Holden-Mount S et al. Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper. Wound Repair and Regeneration. 2014;22(3):301-304. doi:10.1111/wrr.12183
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10. Kalyani V, Mohanasundari S. A Patient Safety: Preventing Pressure Ulcers. Indian Journal of Surgical Nursing. 2016;5(3):97-105. doi:10.21088/ijsn.2277.467x.5316.5
11. Montgomerie J. Infections in Patients with Spinal Cord Injuries. Clinical Infectious Diseases. 1997;25(6):1285-1290. doi:10.1086/516144
12. Wall B, Mangold T, Huch K, Corbett C, Cooke R. Bacteremia In The Chronic Spinal Cord Injury Population: Risk Factors For Mortality. J Spinal Cord Med. 2003;26(3):248-253. doi:10.1080/10790268.2003.11753692
13. Dana A, Bauman W. Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know. J Spinal Cord Med. 2014;38(2):147-160 doi:10.1179/2045772314y.0000000234
14. Nakade D, Zade D, Mehta D, Gupta D, Pandita D. Role of vacuum assisted closure (VAC) in treatment of difficult to heal wounds in lower extremity- our experience in 100 cases. International Journal of Surgery Science. 2020;4(1):445-450. doi:10.33545/surgery.2020.v4.i1h.383
15. MS D, MS D. VAC (Vacuum assisted closure) in the management of chronic non-healing wounds: Institutional study. International Journal of Surgery Science. 2020;4(4):82-86. doi:10.33545/surgery.2020.v4.i4b.543
16. Morykwas M, Argenta L, Shelton-Brown E, McGuirt W. Vacuum-Assisted Closure: A New Method for Wound Control and Treatment. Ann Plast Surg. 1997;38(6):553-562. doi:10.1097/00000637-199706000-00001
17. Brem H, Sheehan P, Rosenberg H, Schneider J, Boulton A. Evidence-Based Protocol for Diabetic Foot Ulcers. PlastReconstr Surg. 2006;117(SUPPLEMENT):193S-209S. doi:10.1097/01.prs.0000225459.93750.29
18. Lemaire V, Boulanger K, Heymans O. Free Flaps for Pressure Sore Coverage. Ann Plast Surg. 2008;60(6):631-634. doi:10.1097/sap.0b013e31812c1465
19. Marchi M. Surgical reconstructive procedures for treatment of ischial, sacral and trochanteric pressure ulcers. Giornale di Chirurgia - Journal of Surgery. 2015. doi:10.11138/gchir/2015.36.3.112
20. Rubayi S, Chandrasekhar B. Trunk, Abdomen, and Pressure Sore Reconstruction. PlastReconstr Surg. 2011;128(3):201e-215e. doi:10.1097/prs.0b013e31822214c1
21. Cushing C, Phillips L. Evidence-Based Medicine. PlastReconstr Surg. 2013;132(6):1720-1732. doi:10.1097/prs.0b013e3182a808ba
22. Jordan S, De la Garza M, Lewis V. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017;70(7):959-966. doi:10.1016/j.bjps.2017.01.004
23. Laing T, Ekpete N, Oon S, Carroll S. Surgical Reconstruction of Pressure Ulcer Defects. Journal of Wound, Ostomy & Continence Nursing. 2010;37(6):615-618. doi:10.1097/won.0b013e3181f90d03
24. Braafhart M, de Laat H, Wagner T, van de Burgt E, Hummelink S, Ulrich D. Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach?.J Tissue Viability. 2020;29(4):319-323. doi:10.1016/j.jtv.2020.08.004
25. Mathes S. Plastic Surgery. Philadelphia [u.a.]: Saunders Elsevier; 2006.
26. Plastic Surgery Vol II. Philadelphia, PA: Saunders; 2006.
27. Yasar B, Duru C, Ergani H, Kaplan A, Igde M, Unlu R. Safe and easy way to reconstruct pressure ulcers: Gluteal artery perforator flaps. Turkish Journal of Plastic Surgery. 2019;27(4):193. doi:10.4103/tjps.tjps_102_18
28. Greenway R, Littell A, Houser H, Lindan O, Weir D. An Evaluation of the Variability in Measurement of Some Body Composition Parameters. Experimental Biology and Medicine. 1965;120(2):487-492. doi:10.3181/00379727-120-30569
29. Resnick N, Beckett L, Branch L, Scherr P, Wetle T. Short-Term Variability of Self Report of Incontinence in Older Persons. J Am Geriatr Soc. 1994;42(2):202-207. doi:10.1111/j.1532-5415.1994.tb04953.x
30. Chassagne P, Landrin I, Neveu C et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med. 1999;106(2):185-190. doi:10.1016/s0002-9343(98)00407-0
31. Tam E, Mak A, Lam W, Evans J, Chow Y. Pelvic movement and interface pressure distribution during manual wheelchair propulsion11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil. 2003;84(10):1466-1472. doi:10.1016/s0003-9993(03)00269-7
32. Borgognone A, Anniboletti T, De Vita F, Schirosi M, Palombo P. Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way. Spinal Cord. 2010;48(10):770-773. doi:10.1038/sc.2010.25
33. Bertheuil N, Aillet S, Heusse J, Tawfik M, Campillo-Gimenez B, Watier E. Ischial Pressure Ulcers. Ann Plast Surg. 2014;73(6):686-691. doi:10.1097/sap.0b013e31828587f0
34. Acute Pyogenic Arthritis of the Hip: An Operation Giving Free Access and Effective Drainage. Clinical Orthopaedics & Related Research. 2008;466(2):258-263. doi:10.1007/s11999-007-0082-6
35. Scheel-Sailer A, Wyss A, Boldt C, Post M, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord. 2013;51(11):828-833. doi:10.1038/sc.2013.91
36. Lance J. What is spasticity?.The Lancet. 1990;335(8689):606. doi:10.1016/0140-6736(90)90389-m
37. Levi R, Hultling C, Seiger Å. The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems. Spinal Cord. 1995;33(10):585-594. doi:10.1038/sc.1995.125
38. Hon A, Kraus P. Spasticity Management After Spinal Cord Injury. Curr Phys Med Rehabil Rep. 2020;8(3):159-171. doi:10.1007/s40141-020-00280-6
39. Negosanti L, Sanguinetti G, Gaiani L et al. Spinal cord injury patients with spasticity and pressure sores: Preliminary report on reconstruction with botulinum toxin treated muscle flaps. Integr Mol Med. 2019;6(5). doi:10.15761/imm.1000377
40. Shayan R, Hurley A, Neoh D, Flood D, Weymouth M. Reconstructing ‘dual-defect’ pressure sores in spinal patients. Australasian Journal of Plastic Surgery. 2019;2(2):21-27. doi:10.34239/ajops.v2n2.107
2. Cowan L, Ahn H, Flores M et al. Pressure Ulcer Prevalence by Level of Paralysis in Patients With Spinal Cord Injury in Long-term Care. Adv Skin Wound Care. 2019;32(3):122-130. doi:10.1097/01.asw.0000553109.70752.bf
3. Chen C, Chiang I, Ou K et al. Surgical treatment and strategy in patients with pressure sores. Medicine (Baltimore). 2020;99(44):e23022. doi:10.1097/md. 0000000000023022
4. Gusenoff J, Redett R, Nahabedian M. Outcomes for Surgical Coverage of Pressure Sores in Nonambulatory, Nonparaplegic, Elderly Patients. Ann Plast Surg. 2002;48(6):633-640. doi:10.1097/00000637-200206000-00012
5. Legemate C, van der Kwaak M, Gobets D, Huikeshoven M, van Zuijlen P. The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2018;71(6):889-894. doi:10.1016/j.bjps.2018.01.032
6. Buck E, Rintala D, Hart K, Clearman R, Fuhrer M. Utilization of health care services by persons with spinal cord injury living in the community. Arch Phys Med Rehabil. 1993;74(6):672-673. doi:10.1016/0003-9993(93)90252-6
7. Cooper L, Vellodi C, Stansby G, Avital L. The prevention and management of pressure ulcers: summary of updated NICE guidance. J Wound Care. 2015;24(4):179-184. doi:10.12968/jowc.2015.24.4.179
8. Tew C, Hettrick H, Holden-Mount S et al. Recurring pressure ulcers: Identifying the definitions. A National Pressure Ulcer Advisory Panel white paper. Wound Repair and Regeneration. 2014;22(3):301-304. doi:10.1111/wrr.12183
9. Kamińska M, Cybulska A, Skonieczna-Żydecka K, Augustyniuk K, Grochans E, Karakiewicz B. Effectiveness of Hydrocolloid Dressings for Treating Pressure Ulcers in Adult Patients: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(21):7881. doi:10.3390/ijerph17217881
10. Kalyani V, Mohanasundari S. A Patient Safety: Preventing Pressure Ulcers. Indian Journal of Surgical Nursing. 2016;5(3):97-105. doi:10.21088/ijsn.2277.467x.5316.5
11. Montgomerie J. Infections in Patients with Spinal Cord Injuries. Clinical Infectious Diseases. 1997;25(6):1285-1290. doi:10.1086/516144
12. Wall B, Mangold T, Huch K, Corbett C, Cooke R. Bacteremia In The Chronic Spinal Cord Injury Population: Risk Factors For Mortality. J Spinal Cord Med. 2003;26(3):248-253. doi:10.1080/10790268.2003.11753692
13. Dana A, Bauman W. Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know. J Spinal Cord Med. 2014;38(2):147-160 doi:10.1179/2045772314y.0000000234
14. Nakade D, Zade D, Mehta D, Gupta D, Pandita D. Role of vacuum assisted closure (VAC) in treatment of difficult to heal wounds in lower extremity- our experience in 100 cases. International Journal of Surgery Science. 2020;4(1):445-450. doi:10.33545/surgery.2020.v4.i1h.383
15. MS D, MS D. VAC (Vacuum assisted closure) in the management of chronic non-healing wounds: Institutional study. International Journal of Surgery Science. 2020;4(4):82-86. doi:10.33545/surgery.2020.v4.i4b.543
16. Morykwas M, Argenta L, Shelton-Brown E, McGuirt W. Vacuum-Assisted Closure: A New Method for Wound Control and Treatment. Ann Plast Surg. 1997;38(6):553-562. doi:10.1097/00000637-199706000-00001
17. Brem H, Sheehan P, Rosenberg H, Schneider J, Boulton A. Evidence-Based Protocol for Diabetic Foot Ulcers. PlastReconstr Surg. 2006;117(SUPPLEMENT):193S-209S. doi:10.1097/01.prs.0000225459.93750.29
18. Lemaire V, Boulanger K, Heymans O. Free Flaps for Pressure Sore Coverage. Ann Plast Surg. 2008;60(6):631-634. doi:10.1097/sap.0b013e31812c1465
19. Marchi M. Surgical reconstructive procedures for treatment of ischial, sacral and trochanteric pressure ulcers. Giornale di Chirurgia - Journal of Surgery. 2015. doi:10.11138/gchir/2015.36.3.112
20. Rubayi S, Chandrasekhar B. Trunk, Abdomen, and Pressure Sore Reconstruction. PlastReconstr Surg. 2011;128(3):201e-215e. doi:10.1097/prs.0b013e31822214c1
21. Cushing C, Phillips L. Evidence-Based Medicine. PlastReconstr Surg. 2013;132(6):1720-1732. doi:10.1097/prs.0b013e3182a808ba
22. Jordan S, De la Garza M, Lewis V. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017;70(7):959-966. doi:10.1016/j.bjps.2017.01.004
23. Laing T, Ekpete N, Oon S, Carroll S. Surgical Reconstruction of Pressure Ulcer Defects. Journal of Wound, Ostomy & Continence Nursing. 2010;37(6):615-618. doi:10.1097/won.0b013e3181f90d03
24. Braafhart M, de Laat H, Wagner T, van de Burgt E, Hummelink S, Ulrich D. Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach?.J Tissue Viability. 2020;29(4):319-323. doi:10.1016/j.jtv.2020.08.004
25. Mathes S. Plastic Surgery. Philadelphia [u.a.]: Saunders Elsevier; 2006.
26. Plastic Surgery Vol II. Philadelphia, PA: Saunders; 2006.
27. Yasar B, Duru C, Ergani H, Kaplan A, Igde M, Unlu R. Safe and easy way to reconstruct pressure ulcers: Gluteal artery perforator flaps. Turkish Journal of Plastic Surgery. 2019;27(4):193. doi:10.4103/tjps.tjps_102_18
28. Greenway R, Littell A, Houser H, Lindan O, Weir D. An Evaluation of the Variability in Measurement of Some Body Composition Parameters. Experimental Biology and Medicine. 1965;120(2):487-492. doi:10.3181/00379727-120-30569
29. Resnick N, Beckett L, Branch L, Scherr P, Wetle T. Short-Term Variability of Self Report of Incontinence in Older Persons. J Am Geriatr Soc. 1994;42(2):202-207. doi:10.1111/j.1532-5415.1994.tb04953.x
30. Chassagne P, Landrin I, Neveu C et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med. 1999;106(2):185-190. doi:10.1016/s0002-9343(98)00407-0
31. Tam E, Mak A, Lam W, Evans J, Chow Y. Pelvic movement and interface pressure distribution during manual wheelchair propulsion11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil. 2003;84(10):1466-1472. doi:10.1016/s0003-9993(03)00269-7
32. Borgognone A, Anniboletti T, De Vita F, Schirosi M, Palombo P. Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a ‘criss-cross’ way. Spinal Cord. 2010;48(10):770-773. doi:10.1038/sc.2010.25
33. Bertheuil N, Aillet S, Heusse J, Tawfik M, Campillo-Gimenez B, Watier E. Ischial Pressure Ulcers. Ann Plast Surg. 2014;73(6):686-691. doi:10.1097/sap.0b013e31828587f0
34. Acute Pyogenic Arthritis of the Hip: An Operation Giving Free Access and Effective Drainage. Clinical Orthopaedics & Related Research. 2008;466(2):258-263. doi:10.1007/s11999-007-0082-6
35. Scheel-Sailer A, Wyss A, Boldt C, Post M, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord. 2013;51(11):828-833. doi:10.1038/sc.2013.91
36. Lance J. What is spasticity?.The Lancet. 1990;335(8689):606. doi:10.1016/0140-6736(90)90389-m
37. Levi R, Hultling C, Seiger Å. The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems. Spinal Cord. 1995;33(10):585-594. doi:10.1038/sc.1995.125
38. Hon A, Kraus P. Spasticity Management After Spinal Cord Injury. Curr Phys Med Rehabil Rep. 2020;8(3):159-171. doi:10.1007/s40141-020-00280-6
39. Negosanti L, Sanguinetti G, Gaiani L et al. Spinal cord injury patients with spasticity and pressure sores: Preliminary report on reconstruction with botulinum toxin treated muscle flaps. Integr Mol Med. 2019;6(5). doi:10.15761/imm.1000377
40. Shayan R, Hurley A, Neoh D, Flood D, Weymouth M. Reconstructing ‘dual-defect’ pressure sores in spinal patients. Australasian Journal of Plastic Surgery. 2019;2(2):21-27. doi:10.34239/ajops.v2n2.107
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