Kamradt T, Klein S, Zimmermann S, Schröder-Braunstein J, Fürstenberg C H, Hensel C, Weidner N, Hug A
Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
Department of Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany.
Spinal Cord. 2017 Jun;55(6):535-539. doi: 10.1038/sc.2016.186. Epub 2017 Jan 10.
Pressure ulcers impose a major lifetime medical problem to patients with high-grade spinal cord injury (SCI). For patients with stages 3-4 pressure ulcers, plastic surgery is often the only remaining treatment option. Despite considerable flap failure rates of around 30%, only sparse knowledge exists on predictors for flap failure. Hence, identification of predictors for flap failures is needed.
We prospectively enrolled 38 SCI patients with stages 3-4 pressure ulcers scheduled for plastic surgery. Preoperative wound swabs, intraoperative tissue samples and postoperative drainage liquids were microbiologically analyzed. In multivariable logistic regression analyses, bacterial loads of deep tissue cultures of intraoperative samples as well as other clinical variables were analyzed with respect to the prediction of flap failures.
The flap failure rate was 27.5%. Bacterial loads of deep tissue cultures were not predictive for flap failure, neither was the colonization with a specific bacterial strain. We observed a considerable fluctuation of microbiological environment from initial swab cultures, intraoperative samples and postoperative drainage fluids. Antibioprophylaxis was sufficient in only 75% of deep tissue cultures and 69% of drainage fluids. Insufficient antibioprophylaxis was associated with a higher flap failure rates (odds ratio 6.3, confidence interval 1.2-41.0).
After inpatient wound conditioning, bacterial load analysis of intraoperative wound tissue cultures is ineffective in order to predict flap failure rates in SCI patients with stages 3-4 pressure ulcers after flap surgery. Instead, insufficient antibioprophylaxis might be a factor contributing to flap failure.
压疮给高位脊髓损伤（SCI）患者带来了重大的终身医疗问题。对于3-4期压疮患者，整形手术往往是唯一剩下的治疗选择。尽管皮瓣失败率高达30%左右，但关于皮瓣失败预测因素的知识却很匮乏。因此，需要确定皮瓣失败的预测因素。
我们前瞻性纳入了38例计划接受整形手术的3-4期压疮SCI患者。对术前伤口拭子、术中组织样本和术后引流液进行微生物学分析。在多变量逻辑回归分析中，分析术中样本深部组织培养的细菌载量以及其他临床变量对皮瓣失败的预测作用。
皮瓣失败率为27.5%。深部组织培养的细菌载量不能预测皮瓣失败，特定菌株的定植情况也不能预测。我们观察到从初始拭子培养、术中样本到术后引流液，微生物环境有相当大的波动。仅75%的深部组织培养和69%的引流液中的抗生素预防是充分的。抗生素预防不足与较高的皮瓣失败率相关（优势比6.3，置信区间1.2-41.0）。
在住院伤口处理后，术中伤口组织培养的细菌载量分析对于预测3-4期压疮SCI患者皮瓣手术后的皮瓣失败率无效。相反，抗生素预防不足可能是导致皮瓣失败的一个因素。
