Surgery for pressure ulcers in spinal cord ‐injured patients following a structured treatment programme: a 10‐year follow‐up
Abstract With the aim to improve the outcomes for spinal cord‐injured patients undergoing surgery for pressure ulcers, a structured treatment programme regulating pre‐ and postoperative care and rehabilitation was introduced in 2002 in Stockholm. Fifty‐one consecutive patients operated on between 2002 and 2007 were included in a 10‐year follow‐up to evaluate the programme regarding initial healing results and long‐term ulcer and health status. At one month postoperatively, 49 out of 51 (96%) patients were completely healed. Five patients (5/44, 11%) developed recurrent or new ulcers within 3 years of surgery. Two patients were re‐operated on (2/44, 5%). Between 3 and 10 years after surgery, 9 patients (9/33, 27%) had a history of recurrent ulcers, and 6 (6/33, 18%) had a history of new ulcers, a total of 15 patients (15/33, 45%). Of these, three needed re‐operation (3/33, 9 %). The health status values using a visual analogue rating scale were 70 (median) at 3 and 10 years compared with 30 (median) preoperatively. The good initial healing, the low ulcer recurrence rate and the raise in health status indicate the value of a structured treatment programme, especially for the first few postoperative years.
Conclusion: The key lessons learned from this experience are being used to develop a new implementation-focused network. Features felt to be especially important for the SCI KMN includes a highly representative governance structure, the use of indicators within an overall evaluation framework and the systematic application of implementation processes with shared learnings supporting each site. PMID: 31573445 [PubMed - in process]
ConclusionsThe distal partial gluteus maximus musculocutaneous V-Y flap is a simple and new approach with low complication rates for reconstruction of ischial pressure sores. Although there is still not an ideal flap for this challenge, the present technique could be a reliable option for the reconstructive armamentarium.Level of evidence: Level IV, therapeutic study.
Pressure injuries (PIs) are a common yet challenging problem especially in people with spinal cord injury (SCI) because of immobility and anesthetic skin. They are difficult to treat with standard medical care and often recur. Recent interest in the treatment of chronic wounds like PIs has shifted from the type of dressing with or without pharmaceutical topical agents to different therapies like negative pressure wound therapy (NPWT), gene therapy and stem cell based therapies. The rationale behind the use of cell-based therapies is the fact that cells in chronic wounds are phenotypically altered or senescent or both.
Spinal Cord, Published online: 16 July 2019; doi:10.1038/s41393-019-0325-xSevere pressure ulcers requiring surgery impair the functional outcome after acute spinal cord injury
Abstract Not to burn one's bridges. This is the basic principle that comes immediately to the mind of the plastic surgeon when one brings up the secondary surgery of pressure ulcers, which is a common pathology in the spinal cord injured patients. Which ones are good candidates for surgical treatment? When? What preoperative, infectious, rehabilitative management is most likely to minimize the number of failures and recurrences? Which operative technique to prefer in first intention? And in case of secondary surgery, how to choose the best strategy? We will see that some cases can be treated by primarily closing o...
CONCLUSION: Algal polysaccharides possess mechanical and physical properties, along with excellent biocompatibility and biodegradability that make them suitable for a variety of applications as wound dressings. Furthermore, algal polysaccharides have been used for a dual purpose, namely as wound covering, but also as a vehicle for drug delivery to the wound site. PMID: 31109271 [PubMed - as supplied by publisher]
The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis, Published online: 03 May 2019; doi:10.1038/s41393-019-0287-zThe Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis
Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden scale, and the Functional Independence Measure (FIM) for identifying individuals at risk for developing pressure injury (PI) during inpatient spinal cord injury (SCI) rehabilitation.
CONCLUSIONS: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation. PMID: 30943115 [PubMed - as supplied by publisher]
CONCLUSIONS: Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention. PMID: 30834861 [PubMed - in process]