Surgical Treatment of 55 Patients with Pressure Ulcers at the Department of Plastic and Reconstructive Surgery Kosovo during the Period 2000–2010: A Retrospective Study
Objective. The objective of this study is to determine the incidence of PUs, the distribution of PUs, common injuries contributing to the occurrence of PUs in patients admitted to the Department of Plastic and Reconstructive Surgery Kosovo for surgical interventions of PUs, localization of PUs in body, the topical treatment of pressure ulcers before surgical intervention, the methods of surgical interventions, number of surgical interventions, duration of treatment, complications, and mortality. Materials and Methods. This study includes 55 patients with PUs treated surgically in 2000–2010 period in the Department of Plastic and Reconstructive Surgery Kosovo. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package In Stat 3. From statistical parameters arithmetic median and standard deviation were calculated. Data testing is done with -test and the difference is significant if . Conclusion. Despite preventive measures against PUs, the incidence of Pus remains high. 1. Introduction Pressure ulcers (PUs) are defined as localized injury to the skin or underlying tissue usually over bony prominence, as a result of pressure, or pressure in combination with shear or friction [1, 2]. Pressure ulcers are almost a serious, secondary complication of spinal cord injury that has the potential to interfere with physical, psychological, and social well being and to impact overall quality of life [3]. PUs are classified by the level of visible tissue damage, where stage I PUs exhibit nonblanchable erythematic (i.e., redness) on intact skin, stage II PUs are partial thickness ulcers, and stages III and IV ulcers involve full-thickness damage [4]. They are believed to occur from combination of extrinsic forces such as pressure, shear, and friction and intrinsic factors such as age, malnourishment, and consciousness level that influence a person’s tissue tolerance [5, 6]. Previous studies have identified the following factors as increasing the likelihood of developing a pressure ulcer: immobility, admission to the ICU, malnutrition, incontinence, hypoalbuminemia, spinal cord injury, stroke, reduced level of consciousness, fractures and/or major orthopedic procedure, advanced age, trauma, decreased perfusion, poor wound healing, inadequate nursing care, and chronic illness [7–10]. Contributing risk factors increase the patient’s susceptibility to a complex etiology that causes PUs [11]. Debridement of pressure sores often results in extensive soft tissue defects
References
[1]
L. J. Cowan, J. K. Stechmiller, M. Rowe, et al., “Enhancing Braden pressure ulcer risk assessment in acutely ill adult veterans,” Wound Repair and Regeneration, vol. 20, pp. 137–148, 2012.
[2]
Pressure Ulcer Stages Revised by NPUAP, National Pressure Ulcer Advisory Panel, Press Release, Washington, DC, USA, 2007.
[3]
M. A. Regan, R. W. Teasell, D. L. Wolfe, D. Keast, W. B. Mortenson, and J. A. L. Aubut, “A systematic review of therapeutic interventions for pressure Ulcers after spinal cord injury,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 2, pp. 213–231, 2009.
[4]
B. M. Bates-Jensen, H. E. McCreath, V. Pongquan, and N. C. R. Apeles, “Subepidermal moisture differentiates erythema and stage I pressure ulcers in nursing home residents,” Wound Repair and Regeneration, vol. 16, no. 2, pp. 189–197, 2008.
[5]
M. M. Metassan, “Pressure ulcers in the medical wards of RIPAS Hospital: incidence and risk factors,” Brunei International Medical Journal, vol. 7, no. 3, article 157, 2011.
[6]
R. M. Allman, “Pressure ulcer prevalence, incidence, risk factors, and impact,” Clinics in Geriatric Medicine, vol. 13, no. 3, pp. 421–436, 1997.
[7]
E. F. Reilly, G. C. Karakousis, P. Sherwin, et al., “Pressure ulcers in the intensive care unit: the forgotten enemy,” OPUS 12 Scientist, vol. 1, no. 2, 2007.
[8]
S. R. Eachempati, L. J. Hydo, and P. S. Barie, “Factors influencing the development of decubitus ulcers in critically ill surgical patients,” Critical Care Medicine, vol. 29, no. 9, pp. 1678–1682, 2001.
[9]
M. Edwards, “The rationale for the use of risk calculators in pressure sore prevention, and the evidence of the reliability and validity of published scales,” Journal of advanced nursing, vol. 20, no. 2, pp. 288–296, 1994.
[10]
L. E. Herman and K. F. Rothman, “Prevention, care, and treatment of pressure (decubitus) ulcers in intensive care unit patients,” Journal of Intensive Care Medicine, vol. 4, no. 3, pp. 117–123, 1989.
[11]
J. K. Stechmiller, L. Cowan, J. D. Whitney et al., “Guidelines for the prevention of pressure ulcers,” Wound Repair and Regeneration, vol. 16, no. 2, pp. 151–168, 2008.
[12]
Y. Xu, H. Hai, Z. Liang, S. Feng, and C. Wang, “Pedicled fasciocutaneous flap of multi-island design for large sacral defects,” Clinical Orthopaedics and Related Research, vol. 467, no. 8, pp. 2135–2141, 2009.
[13]
Y. Liu, X. Zhang, and C. Zhang, “Clinical typing and surgical principle of pressure sore,” Zhongguo xiu fu chong jian wai ke za zhi, vol. 21, no. 9, pp. 932–936, 2007.
[14]
H. Menke, “Infected decubitus ulcer in German,” Langenbecks Archiv für Chirurgie. Supplement. Kongressband, vol. 114, pp. 517–520, 1997.
[15]
J. L. Grolleau, J. F. Collin, J. P. Chavoin, and M. Costagliola, “Iliac transosseous transposition of a rectus abdominis flap to cover a sacral pressure sore,” Annales de Chirurgie Plastique et Esthetique, vol. 39, no. 1, pp. 128–131, 1994 (French).
[16]
V. Lemaire, K. Boulanger, and O. Heymans, “Free flaps for pressure sore coverage,” Annals of Plastic Surgery, vol. 60, no. 6, pp. 631–634, 2008.
[17]
J. Kottner, K. Raeder, R. Halfens, and T. Dassen, “A systematic review of interrater reliability of pressure ulcer classification systems,” Journal of Clinical Nursing, vol. 18, no. 3, pp. 315–336, 2009.
[18]
R. M. Allman, P. S. Goode, M. M. Patrick, N. Burst, and A. A. Bartolucci, “Pressure ulcer risk factors among hospitalized patients with activity limitation,” Journal of the American Medical Association, vol. 273, no. 11, pp. 865–870, 1995.
[19]
N. Graves, F. A. Birrell, and M. Whitby, “Modeling the economic losses from pressure ulcers among hospitalized patients in Australia,” Wound Repair and Regeneration, vol. 13, no. 5, pp. 462–467, 2005.
[20]
J. Schiffman, M. S. Golinko, A. Yan, A. Flattau, M. Tomic-Canic, and H. Brem, “Operative debridement of pressure ulcers,” World Journal of Surgery, vol. 33, no. 7, pp. 1396–1402, 2009.
[21]
P. C. Nogueira, M. H. L. Caliri, and V. J. Haas, “Profile of patients with spinal cord injuries and occurrence of pressure ulcer at a university hospital,” Revista Latino-Americana de Enfermagem, vol. 14, no. 3, pp. 372–377, 2006.
[22]
J. Alderden, J. D. Whitney, S. M. Taylor, et al., “Risk profile characteristics associated with outcomes of hospital-acquired pressure ulcers: a retrospective review,” Critical Care Nurse, vol. 31, pp. 30–43, 2011.
