Multi-disciplinary management of complex pressure sore reconstruction: 5-year review of experience in a spinal injuries centre

Abstract

INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide descriptive data as well as share the experience of treating these complex wounds. MATERIALS AND METHODS Patients operated on as a joint case from 2010 to 2014 were identified through a locally held database and hospital records were then retrospectively reviewed for perioperative variables. Descriptive statistics were collected. RESULTS 12 patients underwent 15 procedures as a joint collaboration between plastic surgery and other surgical specialties: one with spinal surgery, 12 with orthopaedic and two with both orthopaedic and urology involvement. Ischial and trochanteric wounds accounted for 88% of cases with five Girdlestone procedures being performed and 12 requiring soft-tissue flap reconstruction. Mean operative time was 3.8hours. Four patients required high-dependency care and 13 patients received long-term antibiotics. Only three minor complications (20%) were seen with postoperative wound dehiscence. DISCUSSION The multidisciplinary team clinic allows careful assessment and selection of patients appropriate for surgical reconstruction and to help match expectations and limitations imposed by surgery, which are likely to influence their current lifestyle in this largely independent patient group. Collaboration with other specialties gives the best surgical outcome both for the present episode as well as leaving avenues open for potential future reconstruction.

Keywords: Orthopaedics; Plastic; Pressure ulcer; Reconstructive surgical procedures; Spinal injuries; Surgery; Urology.

Figure 1

Example case (patient 1 in Table 1) of complex pressure ulcer reconstruction in a patient with a T3-level spinal injury: 1) preoperative – right grade 4 trochanteric and ischial pressure ulcers with underlying osteomyelitis; 2) post-debridement and Girdlestone procedure showing extent of defect; 3) elevation of gluteal myocutaneous rotation flap; 4) vastus lateralis and tensor fascia lata muscle flap elevated and transposed to fill post-debridement defect; 5) gluteal myocutaneous flap advanced to allow closure; 6) 3 weeks postoperatively with satisfactory healing

Figure 2

Method of reconstruction employed