The medical and surgical care chain in neuro-injured patients : the experience of the Nantes University Hospital from 2004 to 2014.
Mrs Chloë LEFÈVREa, Dr Frédérique BELLIER WAASTb, Dr Pierre KIÉNYa, Dr Florence LEJEUNEb, Dr Marc LEFORTa, Prof Brigitte PERROUIN-VERBEa
a CHU Nantes, service de MPR Neurologique, b CHU Nantes, service de Chirurgie Plastique
Introduction : The management of pressure sores in neuro-injured patients at the Nantes University Hospital was organized for 30 years in a medical-surgical care chain. The last ten years of this activity are traced in this retrospective study.
Patients and Methods : All records of patients who had a surgical flap to cover pressure sore between 1 January 2004 and 31 December 2014 were analysed to synthesize results.
Results : 113 men and 49 women (n = 162) were operated of 250 flaps. This was mainly spinal cord injured patients (78%). Patients were divided into two groups: pressure ulcer (s) single or multiple (several lesions operated at the same time or later). There were 67% of ischial lesions, 20% of sacral lesions and 12% trochanteric lesions. The most used flap was that of gluteus maximus (82%) for the ischial and sacral lesions, then comes the tensor fascia lata (12%) for trochanteric lesions. Feature of our serie (unlike others(1)), the hamstring’s flap is only used as a last resort (6%) in multirecidivist patients. The complication rate delaying delivery to the chair in theoretical time of six weeks is 35%, to be analysed according to age, general health, the size and number of initial lesions... However the rate of recurrence after healing of the flap is only 10%.
Discussion : A medical and surgical management, long and sometimes complex (2), but our long-term results are satisfactory regarding to the low recurrence rate.
(1) Surgical issues and outcomes in ischial pressure sores treatment.
Voulliaume D, Grecea M, Viard R, Brun A, Comparin JP, Foyatier JL. Ann Chir Plast Esthet. 2011 Dec;56(6):528-39
(2) A retrospective study on flap complications after pressure ulcer surgery in spinal cord-injured patients
B Biglari1, A Büchler, T Reitzel, T Swing, H J Gerner,T Ferbertand A Moghaddam. Spinal Cord (2014) 52, 80-83.
Keywords : pressure ulcer, pressure sore, decubitus ulcer, surgical flap, spinal cord injury