Reconstructive Surgery of Pressure Injuries in Spinal Cord Injury/Disorder Patients: Retrospective Observational Study and Proposal of an Algorithm for the Flap Choice

Healthcare, 2024 · DOI: https://doi.org/10.3390/healthcare12010034 · Published: December 22, 2023

Simple Explanation

Pressure injuries (PIs) are a common issue for individuals with spinal cord injuries (SCI/D). Deep PIs often require surgery to remove damaged tissue and rebuild the area. This study looks back at surgeries done on SCI/D patients with severe PIs, using a method to pick the best type of tissue flap for reconstruction based on the wound location and other factors. The goal was to see how often complications happened after surgery and what might cause them. The study reviewed surgeries performed between July 2011 and January 2018. The results showed that certain locations of PIs and the type of flap used could increase the risk of complications.

Study Duration

July 2011 and January 2018

Participants

375 SCI/D patients

Evidence Level

Retrospective observational study

Key Findings

1
Sacral PIs were associated with a higher risk of minor complications post-surgery.
2
Vascular etiology of SCI/D was associated with a significantly higher risk of major complications.
3
The type of reconstructive flap used and the location of the pressure injury are correlated to the outcomes of reconstruction.

Research Summary

This retrospective study analyzed surgical procedures for pressure injuries (PIs) in spinal cord injury/disorder (SCI/D) patients, focusing on postoperative complications and recurrence using a specific flap selection algorithm. The study found that sacral PIs were linked to increased minor complications, while vascular etiology of SCI/D was associated with higher major complication risks. The type of reconstructive flap and PI location impact reconstruction outcomes. The authors advocate for reconstructive planning based on established principles, careful consideration of flap choice, and a multidisciplinary approach to optimize surgical outcomes in this complex patient population.

Practical Implications

Algorithm Integration

The described flap choice algorithm should be considered for integration into existing treatment protocols due to the satisfactory results achieved.

Multidisciplinary Approach

A multidisciplinary approach is crucial for managing SCI/D patients with PIs, involving various specialists to address the complex aspects of this pathology.

Personalized Flap Selection

Reconstructive planning should be based on confirmed principles, with careful consideration of flap choice to minimize complications and allow for future reconstructive options if recurrence occurs.

Study Limitations

1
Retrospective nature of the study
2
Potential bias due to using fasciocutaneous flaps in non-scarred sites and muscular flaps in scarred sites
3
Limited generalizability due to the specific patient population and treatment protocols at a single center

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