The Role of Reconstructive Surgery for Treating Pressure Injuries – A Review of Literature
DOI:
https://doi.org/10.12775/QS.2024.37.57709Keywords
pressure injuries, reconstructive surgery, plastic surgery, chronic wounds, surgical managementAbstract
Pressure injuries (PIs) represent a significant global health challenge, affecting approximately 10.8% of the European population in 2019. Their development is primarily attributed to ischemia and tissue necrosis resulting from prolonged pressure. According to the NPIAP classification, PIs are categorized into four stages, with surgical intervention predominantly indicated for stage III and IV ulcers. Reconstructive surgery encompasses various techniques, with debridement (the removal of necrotic tissue) being the most frequently performed procedure. An essential component of the healing process is negative pressure wound therapy (NPWT), which facilitates oxygen delivery to deeper tissue layers and promotes faster regeneration. Promising outcomes have also been observed with the use of regional flaps, particularly in the management of large bedsores and cases where other options are no longer viable. Despite advancements in surgical treatments, challenges such as graft rejection and high recurrence rates persist. The selection of the surgical approach should be guided by the patient’s overall health status and the specific characteristics of the ulcer. Effective management of PIs is critical for preventing prolonged hospitalizations and mitigating the risk of hospital-acquired infections, thereby significantly improving patients' quality of life.References
1. Chou R, Dana T, Bougatsos C, Blazina I, Starmer AJ, Reitel K, et al. Pressure Ulcer Risk Assessment and Prevention: A Systematic Comparative Effectiveness Review. Ann Intern Med. 2013 Jul 2;159(1):28.
2. Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care. 2020 Jun 2;29(6):312–20.
3. Cox J, Schallom M, Jung C. Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients. Am J Crit Care. 2020 May 1;29(3):204–13.
4. Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J. 2022 Mar;19(3):692–704.
5. Gefen A, Ousey K. COVID-19: pressure ulcers, pain and the cytokine storm. J Wound Care. 2020 Oct 2;29(10):540–2.
6. Chung M, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, et al. Risk factors for pressure ulcers in adult patients: A meta‐analysis on sociodemographic factors and the Braden scale. J Clin Nurs. 2023 May;32(9–10):1979–92.
7. The National Pressure Injury Advisory Panel (NPIAP). NPIAP Pressure Injury Stages [Internet]. 2016 [cited 2025 Jan 6]. Available from: https://cdn.ymaws.com/npiap.com/resource/resmgr/online_store/npiap_pressure_injury_stages.pdf
8. Lin‐Yin W, Chia‐Ming L, Lin H, Chu‐Yu C, Tzeng Y. Risk factors for recurrent pressure ulcers after reconstructive surgery: A retrospective study in a single medical centre. Int Wound J. 2023 Sep;20(7):2511–7.
9. Norman G, Wong JK, Amin K, Dumville JC, Pramod S. Reconstructive surgery for treating pressure ulcers. Cochrane Wounds Group, editor. Cochrane Database Syst Rev [Internet]. 2022 Oct 13 [cited 2025 Jan 7];2022(10). Available from: http://doi.wiley.com/10.1002/14651858.CD012032.pub3
10. Kasai T, Isayama T, Sekido M. Squamous cell carcinoma arising from an ischial pressure ulcer initially suspected to be necrotizing soft tissue infection: A case report. J Tissue Viability. 2021 Nov;30(4):621–5.
11. Hsu KF, Kao LT, Chu PY, Chen CY, Chou YY, Huang DW, et al. Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon. J Pers Med. 2022 Jan 29;12(2):182.
12. Sørensen JL, Jørgensen B, Gottrup F. Surgical treatment of pressure ulcers. Am J Surg. 2004 Jul;188(1):42–51.
13. Serra R, Rizzuto A, Rossi A, Perri P, Barbetta A, Abdalla K, et al. Skin grafting for the treatment of chronic leg ulcers – a systematic review in evidence‐based medicine. Int Wound J. 2017 Feb;14(1):149–57.
14. Nesbit R, Laub D. Random Skin Flaps [Internet]. 2021 [cited 2025 Jan 6]. Available from: https://emedicine.medscape.com/article/1284569-overview
15. Chen CY, Chiang IH, Ou KL, Chiu YL, Liu HH, Chang CK, et al. Surgical treatment and strategy in patients with pressure sores: A single-surgeon experience. Medicine (Baltimore). 2020 Oct 30;99(44):e23022.
16. Thiessen FE, Andrades P, Blondeel PN, Hamdi M, Roche N, Stillaert F, et al. Flap surgery for pressure sores: Should the underlying muscle be transferred or not? J Plast Reconstr Aesthet Surg. 2011 Jan;64(1):84–90.
17. Robertson K. Fasciocutaneous Flaps [Internet]. 2023 [cited 2025 Jan 6]. Available from: https://emedicine.medscape.com/article/1284631-overview
18. Velazquez-Mujica J, Losco L, Aksoyler D, Chen HC. Perforator-to-perforator anastomosis as a salvage procedure during harvest of a perforator flap. Arch Plast Surg. 2021 Jul 15;48(4):467–9.
19. Lemaire V, Boulanger K, Heymans O. Free Flaps for Pressure Sore Coverage. Ann Plast Surg. 2008 Jun;60(6):631–4.
20. McCarthy JE, Rao VK. Systematic Review and Operative Technique of Recalcitrant Pressure Ulcers Using a Fillet Flap Technique. Plast Reconstr Surg - Glob Open. 2016 Aug;4(8):e1001.
21. Di Caprio G, Serra-Mestre JM, Ziccardi P, Scioli M, Larocca F, Nunziata V, et al. Expanded Flaps in Surgical Treatment of Pressure Sores: Our Experience for 25 Years. Ann Plast Surg. 2015 Nov;75(5):552–5.
22. Geoghegan L, Nikkhah D. Ten technical considerations revisited in tissue expansion. J Surg Case Rep. 2020 Aug 1;2020(8):rjaa273.
23. Song Y, Wang L, Yuan B, Shen H, Du L, Cai J, et al. Negative‐pressure wound therapy for III / IV pressure injuries: A meta‐analysis. Wound Repair Regen. 2021 Jan;29(1):20–33.
24. Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Wounds Group, editor. Cochrane Database Syst Rev [Internet]. 2022 Apr 26 [cited 2025 Jan 7];2022(4). Available from: http://doi.wiley.com/10.1002/14651858.CD009261.pub7
25. González‐Méndez MI, Lima‐Serrano M, Martín‐Castaño C, Alonso‐Araujo I, Lima‐Rodríguez JS. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit. J Clin Nurs. 2018 Mar;27(5–6):1028–37.
26. Liu P, He W, Chen HL. Diabetes Mellitus as a Risk Factor for Surgery-Related Pressure Ulcers: A Meta-analysis. J Wound Ostomy Continence Nurs. 2012 Sep;39(5):495–9.
27. Radkowski P, Kędziora B, Eliszewska L, Jackowska K, Mandziuk-Radkowska O, Dawidowska-Fidrych J. Perioperative management of patients with diabetes. Med Stud. 2023;39(3):272–80.
28. Medical Advisory Secretariat. Management of chronic pressure ulcers: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9(3):1–203.
29. Bielecki M, Bielecki P, Żebrowski P, Misiak B, Lewko J. Operative treatment of pressure ulcers using pedicled flaps. Prog Health Sci. 2018 Dec 31;8(2):105–11.
30. Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J. A Systematic Review of Complication and Recurrence Rates of Musculocutaneous, Fasciocutaneous, and Perforator-Based Flaps for Treatment of Pressure Sores. Plast Reconstr Surg. 2012 Jul;130(1):67e–77e.
31. Huang C, Lee S, Chiu W, Chen C, Chen J, Wang H. Determinants of the success in flap reconstruction—Outcome analysis of 120 flaps in 484 procedures for pressure injury. Int Wound J. 2023 Oct;20(8):3105–15.
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