scholarly journals Reconstructing ‘dual-defect’ pressure sores in spinal patients

2019 ◽  
Vol 2 (2) ◽  
pp. 21-27
Author(s):  
Ramin Shayan ◽  
Aoife Margaret Hurley ◽  
Derek Neoh ◽  
Dr Stephen Flood ◽  
Michael Weymouth
Keyword(s):  
Postoperative Complications ◽  
Spinal Injury ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Anatomical Landmarks ◽  
Greater Trochanter ◽  
Tertiary Referral Centre ◽  
Anterolateral Thigh ◽  
Preoperative Status ◽  
Alt Flap

Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.Methods: Eleven consecutive patients with concurrent pressure sores (> grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

scholarly journals The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

2021 ◽  
Vol 48 (1) ◽  
pp. 114-120
Author(s):  
Mahmoud A. Hifny
Keyword(s):  
Demographic Data ◽  
Pressure Sore ◽  
Good Choice ◽  
Anterolateral Thigh Flap ◽  
Pressure Sores ◽  
Skin Paddle ◽  
Tunneling Method ◽  
Anterolateral Thigh ◽  
Flap Design ◽  
Alt Flap

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap.Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated.Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed.Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

scholarly journals Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

2009 ◽  
Vol 42 (01) ◽  
pp. 126-129
Author(s):  
Sandeep Mehrotra
Keyword(s):  
Perforator Flap ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Ageing Population ◽  
Fasciocutaneous Flaps ◽  
Anterolateral Thigh ◽  
Complex Wounds

ABSTRACTPressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

Role of topical insulin therapy as an adjunct in the management of pressure ulcer

2020 ◽  
Vol 2 (3) ◽  
pp. 01-03
Author(s):  
Ravi Chittoria
Keyword(s):  
Wound Healing ◽  
Insulin Therapy ◽  
Pressure Ulcer ◽  
Healing Rate ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Established Method ◽  
Wound Bed Preparation ◽  
Wound Healing Rate

Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Various adjunctive methods are used for wound bed preparation before definitive reconstruction plan is made. Here we describe our experience in the role of insulin therapy as an adjunct in the management of pressure sores.

scholarly journals The impact of the SARS-CoV-2 pandemic on referral characteristics in a national tertiary spinal injuries unit

2021 ◽  
Author(s):  
Louis O’Halloran ◽  
Daniel P. Ahern ◽  
Jake M. McDonnell ◽  
Gráinne M. Cunniffe ◽  
Michael K. Dodds ◽  
...  
Keyword(s):  
Road Traffic ◽  
Spinal Injury ◽  
Disc Disease ◽  
Tertiary Referral Centre ◽  
Period 2 ◽  
Spine Pathology ◽  
Social Restriction ◽  
Notable Increase ◽  
Almost All ◽  
The Impact

Abstract Background The SARS-CoV-2 pandemic has had profound implications on healthcare institutions. Aims This study aims to assess and compare referral patterns during COVID-19 to corresponding dates for the preceding 3 years (2017–2019), in order to preemptively coordinate the logistics of the surgical unit for similar future experiences. Methods Retrospective review for our institution, a national tertiary referral centre for spine pathology. Two distinct time-points were chosen to represent the varied levels of social restriction during the current pandemic: (i) study period 1 (SP1) from 11 November 2020 to 08 June 2020 represents a national lockdown, and (ii) study period 2 (SP2) from 09 June 2020 to 09 September 2020 indicates an easing of restrictions. Both periods were compared to corresponding dates (CP1: 11 March–08 June and CP2 09 June–09 September) for the preceding 3 years (2017–2019). Data collected included age, gender, and mechanism of injury (MOI) for descriptive analyses. MOIs were categorised into disc disease, cyclist, road-traffic-accident (RTA), falls < 2 m, falls > 2 m, malignancy, sporting injuries, and miscellaneous. Results All MOI categories witnessed a reduction in referral numbers during SP1: disc disease (−29%), cyclist (−5%), RTAs (−66%), falls < 2 m (−39%), falls > 2 m (−17%), malignancy (−33%), sporting injuries (−100%), and miscellaneous (−58%). Four of 8 categories (RTAs, falls < 2 m, malignancy, miscellaneous) showed a trend towards return of pre-lockdown values during SP2. Two categories (disc disease, falls > 2 m) showed a further reduction (−34%, −27%) during SP2. One category (sporting injuries) portrayed a complete return to normal values during SP2 while a notable increase in cyclist-related referrals was witnessed (+ 63%) when compared with corresponding dates of previous years. Conclusion Spinal injury continues to occur across almost all categories, albeit at considerably reduced numbers. RTAs and falls remained the most common MOI. Awareness needs to be drawn to the reduction of malignancy-related referrals to dissuade people with such symptoms from avoiding presentation to hospital over periods of social restrictions.

scholarly journals Prevention and treatment of pressure sore following spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 623-632
Author(s):  
Myeong Ok Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Wound Care ◽  
Pressure Sore ◽  
Therapeutic Interventions ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Cord Injury ◽  
Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

scholarly journals Management of Sacral Pressure Sore by Clinically Isolated Superior Gluteal Artery Perforator-based Fasciocutaneus Flap in Patients with Spinal Cord Injury

2016 ◽  
Vol 27 (1) ◽  
pp. 14-18
Author(s):  
S P Das ◽  
Mamtamanjari Sahu ◽  
Pramod Kumar Parida
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Constant Pressure ◽  
Spinal Injury ◽  
Wound Dehiscence ◽  
Pressure Sore ◽  
Superior Gluteal Artery ◽  
Doppler Probe ◽  
Cord Injury ◽  
Artery Perforator

Abstract Prolong confinement to bed in spinal injury patients imparts constant pressure on bony prominences resulting impairment of blood flow to local tissue. Constant pressure of 2 hours or more produces irreversible changes leading to tissue necrosis and development of pressure sore. Sacrum encounters highest pressure in supine position and is the commonest site of pressure sore in spinal cord injury patients followed by trochanter and heel. Objective of the study Observation on management of sacral pressure sore by superior gluteal arterial perforatorbased flap using anatomical land marks in the absence of facility of Doppler probe for isolation of superior gluteal arterial perforators. Materials and methods Thirteen patients of spinal cord injury presented with sacral pressure sore were managed surgically using superior gluteal artery perforator-based flap coverage. The location of the artery was identifi ed using anatomical land marks. In 10 patients the flap was heeled uneventfully, one had signifi cant complication with wound dehiscence. Conclusions Management of sacral pressure sore by superior gluteal arterial perforator-based flap using anatomical land marks is a simple and reliable procedure. The learning curve is not that stiff. Sophisticated instruments are not required for this procedure.

scholarly journals "Bacteriological Status of Pressure Sore - A Study of 50 Cases"

2013 ◽  
Vol 3 (1) ◽  
pp. 19-23
Author(s):  
SI Hossain ◽  
SH Khundkar
Keyword(s):  
Bacterial Load ◽  
Care Facility ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Quantitative Culture ◽  
Term Care ◽  
Long Term Care Facility ◽  
Sensitivity Pattern ◽  
Significant Difference

Background of the study: Pressure sores are major cause of morbidity and mortality in the patients of the long term care facility. Infected pressure sores are very difficult to treat. Managing pressure sore needs care and expertise. Objectives: To study the bacteriological status of pressure sore by qualitative and quantitative culture and to find out the sensitivity pattern of the isolated bacteria to the various antibiotics. Methods: 50 patients were included in this study. Wound swabs were collected from pressure sore and deep tissue specimen sampled from pressure sore for quantitative culture in 1st and 3rd visit at 20 days interval. Patients with pressure sore were followed up for healing and their wound healing rate according to PUSH Tool 3.0 is correlated with the bacterial load in the pressure sore. Results were summarized in data table and analyzed. Results: Pseudomonas species were found to be most frequent bacterial isolate followed by E.Coli. Next leading isolated bacteria were Staph. Aureus and Proteus. Ceftazidime, Amikacin, Ciprofloxacin and Gentamycin showed higher percentage of sensitivity and organisms mostly resistant to Ampicillin,Amoxycillin, Co trimoxazole,Flucloxacillin, Ceftriaxone. Quantitative culture of the pressure sore revealed that 40.5% of the sore had bacterial load >105 CFU/ gm of tissue and 59.5% had bacterial load <105 CFU/gm of tissue on 1st visit. On 3rd visit quantitative culture of the pressure sore after 20 days showed decrease in frequency of >105 CFU/ gm of tissue to 21( 28.37%). No statistically significant decrease of bacterial load from 1st to 3rd visit noted. No significant difference in healing also noted in between two groups and in different bacterial species.DOI: http://dx.doi.org/10.3329/bdjps.v3i1.15002 Bangladesh Journal of Plastic Surgery 2012, 3(1): 19-23

Reconstruction of trochanteric pressure sores with pedicled anterolateral thigh myocutaneous flaps

2011 ◽  
Vol 64 (5) ◽  
pp. 671-676 ◽  
Author(s):  
Chih-Hsin Wang ◽  
Shih-Yi Chen ◽  
Ju-Peng Fu ◽  
Niann-Tzyy Dai ◽  
Shao-Liang Chen ◽  
...  
Keyword(s):  
Pressure Sores ◽  
Myocutaneous Flaps ◽  
Anterolateral Thigh

The Relationship between Engagement in Occupations and Pressure Sore Development in Saudi Men with Paraplegia

2005 ◽  
Vol 68 (7) ◽  
pp. 307-314 ◽  
Author(s):  
Ruth Cutajar ◽  
Anne Roberts
Keyword(s):  
Occupational Therapy ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Spinal Cord Injuries ◽  
Occupational Therapists ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Level Of Activity ◽  
Occupational Activities ◽  
The Individual

Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988). This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period. The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years. These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.

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