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The short and long-term outcome of pressure ulcer (PU) treatment with tissue flaps in spinal cord injury (SCI) patients has been very variable in the literature. Overall complication rates are reported from 4-50%, and PU recurrence rates are reported from 3-82%1-3. We describe our experience after implementing a strict protocol-based approach to treat SCI PU patients at the Minneapolis VAMC in 2008.
Methods and Materials:
All SCI patients who underwent flap surgery for pressure ulcers went through a strict post-operative protocol. A retrospective study of SCI patients who underwent PU flap surgery from 2008-2013 was performed. Patient demographics, risk factors, complications, and treatment data were collected and analyzed using logistic regression. A p-value of <0.05 was considered significant.
Results:
A total of 53 flaps were performed on 43 patients (all males, Mean age: 66 years). All patients had at least 3-month follow up (Range: 3 months – 54 months). There were 28 (53%) ischial, 18 (34%) sacral, and 7 (14%) trochanteric PU’s treated. There were 25 (58.1%) patients with a history of smoking, but only one patient who quit smoking < 6 weeks prior to the flap. Twenty-five patients (58.1%) had flaps for previous PU in the past. The mean size of the defects needing coverage was 74.76 cm3. There were 25 (47.1%) minor complications (minor wound issues, cellulitis) that all healed within 6 weeks, and 4 (7.5%) major complications (late flap loss requiring a second flap). On multivariate analysis, ex-smokers (quit < 6 weeks) (RR 501.6, P < 0.005), ex-smokers (quit 6 weeks – 1 year) (RR 18.1, p<0.026), ex-smokers (quit >1 year) (RR 13.6, p<0.005), Ventilator-dependent quadriplegics (RR 34.9, p<0.04), quadriplegics (RR 4.7; p<0.02), and patients with history of prior flaps for PU’s (RR 4.9, p<0.02) were major risk factors associated with minor post-operative complications. Perianal ulcers (both sacral and ischial within 5 cm of the anal verge) were associated with major complications (RR 3.35, p<0.03).
Conclusions:
Despite a strict protocol-based approach to treating SCI PU’s, minor complications were very common but easily treated. Additionally, late flap losses and recurrence rates were very low.