Seattle, Wash. From the University of Washington and Puget Sound Veterans' Affairs Hospital.
Plast Reconstr Surg. 2010 Jun;125(6):1725-1734. doi: 10.1097/PRS.0b013e3181d51227.
Pressure ulcers are estimated to be present in more than one-third of patients with spinal cord injury. The rate of recurrence after flap surgery over last 50 years has ranged between 3 and 82 percent, with no trend toward improvement. This study seeks to identify and evaluate patient and operative characteristics associated with flap dehiscence and ulcer recurrence.
A retrospective chart review of all patients who underwent pressure ulcer flap coverage between 1993 and 2008 was performed. Thirty-one demographic and operative variables were collected. Multivariate logistic regression with generalized estimating equation was used to evaluate the effect of significant variables. The primary outcome was recurrence of pressure ulcer at the operative site. Secondary outcomes included flap line dehiscence and the need for operative revision.
There were 88 recurrences of pressure ulcers after flap surgery (39 percent) of 227 operations performed on 135 patients. Thirty-six flaps (16 percent) had dehiscences necessitating return to the operating room. Hemoglobin A1c less than 6 percent and previous same-site flap failure were associated with both dehiscence and recurrence (odds ratios, 2.15 and 3.84; and odds ratios, 6.51 and 3.27). Younger age and albumin less than 3.5 were associated with early flap failure (odds ratios, 5.95 and 2.45). Ischial wound location correlated with late recurrence (odds ratio, 4.01). Patients with multiple risk factors had operative success rates that approached zero.
Confirmation of adequate nutritional status and strict preoperative management of blood glucose may improve operative success rates. The authors propose that operative management should be approached with trepidation, if at all, in young patients with recurrent ischial ulcers.
据估计，超过三分之一的脊髓损伤患者存在压疮。在过去的 50 年中，皮瓣手术后复发率在 3%至 82%之间，没有改善的趋势。本研究旨在确定和评估与皮瓣裂开和溃疡复发相关的患者和手术特点。
对 1993 年至 2008 年间所有接受压疮皮瓣覆盖手术的患者进行回顾性图表审查。收集了 31 个人口统计学和手术变量。使用广义估计方程的多变量逻辑回归来评估显著变量的影响。主要结局是手术部位压疮复发。次要结局包括皮瓣线裂开和需要手术修正。
在 135 名患者的 227 次手术中，皮瓣手术后有 88 例（39%）压疮复发。36 个皮瓣（16%）裂开，需要返回手术室。糖化血红蛋白小于 6%和同一部位皮瓣失败与裂开和复发均相关（比值比，2.15 和 3.84；比值比，6.51 和 3.27）。年龄较小和白蛋白小于 3.5 与早期皮瓣失败相关（比值比，5.95 和 2.45）。坐骨伤口位置与晚期复发相关（比值比，4.01）。具有多种危险因素的患者手术成功率接近零。
确认足够的营养状况和严格的术前血糖管理可能会提高手术成功率。作者提出，如果年轻患者反复发作坐骨溃疡，应谨慎进行手术治疗。
