Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases

SAGE Open Nursing, 2024 · DOI: 10.1177/23779608241229507 · Published: January 2, 2024

Simple Explanation

Pressure injuries are a common and debilitating complication for individuals with spinal cord injuries, significantly impacting their quality of life and independence. This study investigates the surgical outcomes of treating large sacral pressure injuries in SCI patients, specifically focusing on the use of stoma formation. The research team reviewed the cases of 25 SCI patients who underwent intestinal stoma formation followed by reconstructive surgery to address their extensive sacral pressure injuries. The study aimed to assess the frequency of surgical complications and the overall success of this treatment approach. The study concludes that while stoma formation is often considered a last resort, it can be a valuable strategy for SCI patients with severe pressure injuries near the anal region, promoting wound healing. The authors emphasize the importance of tailoring treatment decisions to each patient's unique circumstances.

Study Duration

2015 to 2020

Participants

25 SCI patients

Evidence Level

Retrospective study

Key Findings

1
Successful wound closure was achieved in all 25 patients who underwent stoma formation followed by reconstructive surgery for extensive sacral pressure injuries.
2
Each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before undergoing stoma formation and subsequent reconstructive surgery.
3
Post-operative complications were experienced by 40% of the patients (10 out of 25), with suture dehiscence being the most commonly observed in seven cases.

Research Summary

This retrospective study analyzed the outcomes of stoma formation followed by reconstructive surgery in 25 spinal cord injury (SCI) patients with extensive sacral pressure injuries (PIs). The study found that successful wound closure was achieved in all patients, despite previous unsuccessful surgeries. The median hospital stay was 56 days, and the median wound size was 46.0 cm2. Post-operative complications occurred in 40% of patients, with suture dehiscence being the most common. The study also identified infectious agents and surgical approaches based on PI size and location. The authors conclude that intestinal stoma formation can be a valuable strategy for SCI patients with extensive PIs near the anal region to promote healing, emphasizing the need for tailored decision-making to optimize patient outcomes.

Practical Implications

Clinical Decision-Making

Stoma formation should be considered, particularly for SCI patients with extensive PIs near the anal region, especially before reconstructive surgery.

Interdisciplinary Approach

Multi-disciplinary teams, including doctors, nurses, and physical therapists, are essential for informed decisions regarding SCI and stoma formation.

Further Research

Further clinical studies are needed to refine the timing and necessity of stoma formation in specific scenarios involving medically intractable PIs.

Study Limitations

1
Reliance on a relatively limited body of published work in this specialized field.
2
Inconsistency in research methodology, criteria employed, and analytical frameworks used in existing literature.
3
Modest sample size, focusing on a specific subgroup of TSCI patients with PIs, limiting the ability to draw broad clinical conclusions.

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