Opingari Erika, Laurent Romain, Wan Ho Yee, Wallace David L, Rogers Alan D
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Plast Surg (Oakv). 2024 Dec 22:22925503241308541. doi: 10.1177/22925503241308541.
Pressure injuries, particularly among patients with spinal cord injuries and the elderly, significantly contribute to morbidity, mortality, and financial sequelae. Surgical interventions, including debridement and flaps, may improve outcomes, especially for stage 3 and 4 pressure injuries. This survey assesses Canadian plastic surgeons' perspectives and practices regarding the surgical management of these injuries. A web-based survey was distributed to 405 registered members of the Canadian Society of Plastic Surgeons (CSPS) and remained open for a 6-week period. The 16-question survey explored management practices for pressure injuries and the training associated with resident education. Responses from 129 surgeons (31.8%) were analyzed. Of these, 85% manage stage 3 or 4 pressure injuries, though only 67.5% performed both debridement and flap coverage. The majority believe care should ideally occur in community facilities with plastic surgery coverage rather than being centralized in academic centers, although careful patient selection, perioperative planning, and rehabilitation are critical to justify the surgical investment. Most respondents (83%) agreed that plastic surgery residents should be proficient in both debridement and flap coverage by the end of their training. The survey indicates that most surgeons prefer managing pressure injuries in facilities with adequate plastic surgery support rather than exclusively at academic centers. However, structured management pathways and enhanced training in pressure injury care remain crucial. Future healthcare policy and research should focus on improving care delivery and patient outcomes, ensuring that all facilities involved in this care are equipped with the necessary resources and multidisciplinary expertise.
压疮，尤其是在脊髓损伤患者和老年人中，会显著增加发病率、死亡率和经济负担。手术干预，包括清创术和皮瓣移植术，可能会改善治疗效果，特别是对于3期和4期压疮。本调查评估了加拿大整形外科医生对这些损伤手术治疗的观点和实践。一项基于网络的调查已分发给加拿大整形外科协会（CSPS）的405名注册会员，并开放6周。这项包含16个问题的调查探讨了压疮的管理实践以及与住院医师教育相关的培训。对129名外科医生（31.8%）的回复进行了分析。其中，85%的医生处理3期或4期压疮，不过只有67.5%的医生同时进行清创术和皮瓣覆盖术。大多数人认为理想情况下护理应在有整形外科服务的社区设施中进行，而不是集中在学术中心，尽管仔细的患者选择、围手术期规划和康复对于证明手术投入的合理性至关重要。大多数受访者（83%）同意整形外科住院医师在培训结束时应精通清创术和皮瓣覆盖术。该调查表明，大多数外科医生更喜欢在有足够整形外科支持的设施中处理压疮，而不是仅在学术中心。然而，结构化的管理途径和加强压疮护理培训仍然至关重要。未来的医疗政策和研究应专注于改善护理服务和患者治疗效果，确保参与此类护理的所有设施都配备必要的资源和多学科专业知识。
