Anker Alexandra M, Ruewe Marc, Prantl Lukas, Geis Sebastian, Kehrer Andreas, Baringer Magnus, Schiltz Daniel, Zeman Florian, Vykoukal Jody, Klein Silvan M
From the Center for Plastic, Reconstructive, Aesthetic, and Hand Surgery and Center for Clinical Studies, University Hospital Regensburg; Caritas Hospital St. Josef Regensburg; and Department of Clinical Cancer Prevention and the McCombs Institute for the Early Detection and Treatment of Cancer, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2022 Feb 1;149(2):483-493. doi: 10.1097/PRS.0000000000008766.
Complication rates of up to 46 percent are reported following pressure sore surgery. Pressure sore patients often exhibit ineffective postoperative wound healing despite tension-free flap coverage, necessitating surgical revision and prolonged hospitalization. Rather than pressure sore recurrence, such impaired healing reflects a failed progress through the physiologic stages of the normal wound-healing cascade. The principal objective of the study reported here was to elucidate potentially modifiable inherent variables that predict predisposition to impaired healing and to provide a tool for identifying cases at risk for complicated early postoperative recovery following pressure sore reconstruction.
A retrospective chart review of late-stage (stage 3 or higher) sacral and ischial pressure sore patients who underwent flap reconstruction from 2014 to 2019 was performed. A multivariable logistic regression model was used to identify key patient and operative factors predictive of impaired healing. Furthermore, the Assessment Score to Predict Pressure Sore Impaired Healing (A-PePSI) was established based on the identified risk factors.
In a cohort of 121 patients, 36 percent exhibited impaired healing. Of these, 34 patients suffered from dehiscences, necessitating surgical revision. Statistically significant risk factors comprising late recurrence (OR, 3.8), immobility (OR, 12.4), greater surface (>5 cm diameter; OR, 7.3), and inhibited thrombocytes (aspirin monotherapy; OR, 5.7) were combined to formulate a prognostic scoring system (A-PePSI LIGhT).
The A-PePSI LIGhT score serves as a prognostic instrument for assessing individual risk for impaired healing in pressure sore patients. Preoperative risk stratification supports rational decision-making regarding operative candidacy, allows evidence-based patient counseling, and supports the implementation of individualized treatment protocols. .
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
据报道，压疮手术后的并发症发生率高达46%。尽管采用了无张力皮瓣覆盖，但压疮患者术后伤口愈合往往不佳，需要进行手术修复并延长住院时间。这种愈合受损并非压疮复发，而是反映了在正常伤口愈合级联反应的生理阶段进展失败。本文报道的研究的主要目的是阐明可能可改变的内在变量，这些变量可预测愈合受损的易感性，并提供一种工具，用于识别压疮重建术后早期恢复复杂风险的病例。
对2014年至2019年接受皮瓣重建的晚期（3期或更高）骶骨和坐骨压疮患者进行回顾性病历审查。使用多变量逻辑回归模型确定预测愈合受损的关键患者和手术因素。此外，基于确定的风险因素建立了预测压疮愈合受损的评估评分（A-PePSI）。
在121例患者队列中，36%的患者愈合受损。其中，34例患者出现伤口裂开，需要进行手术修复。具有统计学意义的风险因素包括晚期复发（比值比[OR]，3.8）、活动障碍（OR，12.4）、更大的创面（直径>5 cm；OR，7.3）和血小板抑制（阿司匹林单药治疗；OR，5.7），将这些因素合并以制定一个预后评分系统（A-PePSI LIGhT）。
A-PePSI LIGhT评分可作为评估压疮患者愈合受损个体风险的预后工具。术前风险分层有助于就手术候选资格进行合理决策，允许进行基于证据的患者咨询，并支持实施个体化治疗方案。
临床问题/证据级别：风险，III级。
