Oral Communication

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.

References :

(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