Faculty Collaboration Database

Protocol management of late-stage pressure ulcers: a 5-year retrospective study of 101 consecutive patients with 179 ulcers. Plast Reconstr Surg 2012 Apr;129(4):897-904

Date

12/21/2011

Pubmed ID

22183500

DOI

10.1097/PRS.0b013e3182442197

Scopus ID

2-s2.0-84859422204 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

BACKGROUND: Despite a 12 to 82 percent pressure ulcer recurrence rate, no standard protocol exists for postoperative management. The authors reviewed a single surgeon's experience using a standard protocol: surgery and immediate reconstruction regardless of nutrition, intraoperative bone culture guiding postoperative antibiotic use, and hospital admission for 3 weeks of flat bedrest before graduated sitting.

METHODS: A 5-year retrospective chart review was performed on consecutive surgically treated pressure ulcers. A search of billing records identified 101 patients with 179 ulcers. Data abstracted included demographics, comorbidities, location and stage of ulcers, treatment history with outcomes, and laboratory data.

RESULTS: Seventy-nine percent of the patients were men with a mean age of 49.4 years. Of 179 ulcers, 49.7 percent were ischial, 26.8 percent were sacral, and 19 percent were trochanteric; 87.7 percent of ulcers were stage 4. Primary closure was performed on 45.8 percent; others underwent flap closure. There was no correlation between positive bone cultures and recurrence or complications. The overall recurrence rate was 16.8 percent at a mean period of 435.9 days. New ulcer occurrence was 14.5 percent and the complication rate was 17.3 percent. Admission prealbumin and albumin did not correlate with recurrence or complication. Mean follow-up was 629 days.

CONCLUSIONS: A standard clinical pathway for pressure ulcer treatment improves long-term outcomes; the authors' protocol's validity is supported by low recurrence and complication rates. Nutritional data do not predict outcome. Intraoperative bone cultures are the most valid method of diagnosing osteomyelitis; results should not delay definitive treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Author List

Larson DL, Hudak KA, Waring WP, Orr MR, Simonelic K

Authors

Kristen Ann Klement MD Associate Professor in the Plastic Surgery department at Medical College of Wisconsin
Merle R. Orr MD Assistant Professor in the Physical Medicine and Rehabilitation department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Bone and Bones
Clinical Protocols
Female
Humans
Male
Middle Aged
Osteomyelitis
Postoperative Care
Postoperative Complications
Pressure Ulcer
Recurrence
Young Adult