Background: Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates.
Methods: A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training.
Results: Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55-23.3) and deep dehiscence (OR 12.3, 95% CI 1.99-76.9).
Conclusions: The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.bjps.2017.01.004 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Clinical Presentation and Integrated Management of Pressure Injuries in the Emergency Hospital Setting: A Plastic Surgeon's Perspective.
Healthcare (Basel)
December 2024
Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.
: Pressure injuries are localized areas of tissue damage or necrosis that occur when pressure is applied to the skin for prolonged periods, often over bony prominences, often the sacrum, heels, ischial tuberosities, and greater trochanters. The pathophysiology is complex, involving a combination of mechanical forces, ischemia, and tissue hypoxia. : We conducted a 2-year retrospective study aiming to assess the clinical characteristics, risk factors, and management of pressure injuries in patients admitted to an emergency hospital who underwent a plastic surgery examination.
View Article and Find Full Text PDFSitting pressure during wheelchair propulsion and handcycling: effects of backrest angle, movement intensity and cushion type.
Disabil Rehabil Assist Technol
November 2024
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
The main aim of this study was to compare sitting pressure (peak pressure index (PPI) and peak pressure gradient (PPG)) between a daily wheelchair and fixed-frame handcycle, thereby assessing the effect of handcycle backrest angle, movement intensity and cushion type. Twenty able-bodied participants performed static and dynamic (two intensities) tests in a wheelchair and handcycle. A honeycomb wheelchair cushion and standard foam handcycle cushion were used.
View Article and Find Full Text PDF[Biological total hip arthroplasty combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis].
Zhongguo Gu Shang
November 2024
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China.
Objective: To explore the surgical technique and clinical outcomes of biological total hip arthroplasty(THA) combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis(RA).
Methods: Total of 20 patients(28 hips) with RA secondary to acetabular invagination were treated with THA of bioprosthesis combined with autogenous bone grafting from January 2012 to October 2020, including 5 males(8 hips) and 15 females(20 hips) with an average age of (55.10±4.
Padding the seat of a wheelchair reduces ischial pressure and improves sitting comfort.
Drug Discov Ther
November 2024
Department of Rehabilitation, Seiyu Memorial Hospital, Wakayama, Japan.
In this study, we aimed to examine whether a wheelchair cushion placed directly atop a sling seat or deflection of the sling seat compensated by a pad along with the placement of a wheelchair cushion changed sitting pressure. Additionally, we examined whether these additions changed sitting comfort. For twenty healthy adults who consented to participate, measurements were taken for three types of cushions, each with and without padding, under six conditions.
View Article and Find Full Text PDFTissue Oxygenation in Individuals with Spinal Cord Injury: A Pilot Study.
Adv Exp Med Biol
October 2024
Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland.
Article Synopsis
- Pressure injuries (PI) are serious tissue lesions that heal slowly and can lead to infections, primarily affecting individuals with spinal cord injuries (SCI) due to their reduced mobility and sensation.
- A new alert system utilizing a textile-based near-infrared spectroscopy (NIRS) sensor was developed to monitor tissue oxygen levels (StO) in high-risk areas, such as the buttocks, to prevent PIs.
- Initial tests demonstrated that ST decreased during prolonged sitting, with SCI subjects experiencing a sharper decline, but recovery was observed, showing the sensor's effectiveness without causing skin irritation.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!