Biplanar flap reconstruction for pressure ulcers: experience in patients with immobility from chronic spinal cord injuries

详细信息    查看全文

• 作者：Anupama Mehta ; M.D.^a ; Todd A. Baker ; M.D.^a ; Margo Shoup ; M.D. ; F.A.C.S.^a ; Kirstyn Brownson ; M.D.^a ; Sewit Amde ; M.D.^a ; Erin Doren ; M.D.^a ; Samir Shah ; M.D.^a ; Paul Kuo ; M.D. ; M.S. ; M.B.A. ; F.A.C.S.^a ; Juan Angelats ; M.D. ; F.A.C.S.^a ; ^b ; ^{jangela@lumc.edu}
• 关键词：Decubitus ulcer ; Paraplegia ; Quadriplegia ; Myocutaneous flap ; Fasciocutaneous flap ; Reconstruction biplanar flap ; Biplanar flap ; Rotational flap ; Axial flap ; Complication
• 刊名：The American Journal of Surgery
• 出版年：2012
• 出版时间：March, 2012
• 年：2012
• 卷：203
• 期：3
• 页码：303-307
• 全文大小：314 K

文摘

Background

Surgical therapy for advanced-stage pressure ulcers recalcitrant to healing is a widely accepted practice. The present study examined the incidence of wound recurrence after reconstruction with fasciocutaneous versus combined (biplanar) muscle and fasciocutaneous flaps.

Methods

A retrospective review identified 90 nonambulatory patients with spinal cord injury who underwent reconstruction for persistent decubitus ulcers from 2002 to 2008. Electronic medical records were surveyed for patient comorbidities and postoperative complications. Statistical methods included the Fisher exact test and the Mann-Whitney U test with a 2-sided P value of less than .05.

Results

Among 90 patients reviewed, 33 % (n = 30) received fasciocutaneous flaps and 66 % (n = 60) underwent biplanar reconstruction. Comorbidities were the same between cohorts with the exception of a greater prevalence of diabetes in the biplanar group (27 % vs 50 % ; P < .05). The incidence of recurrence for biplanar flaps (25 % ) was significantly lower than for fasciocutaneous reconstruction (53 % ; P < .01).

Conclusions

Biplanar flap reconstruction should be considered for chronically immobilized patients at high risk for recurrent decubitus ulceration.