Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study

PRS Global Open, 2023 · DOI: 10.1097/GOX.0000000000005451 · Published: December 14, 2023

Simple Explanation

Pressure ulcers pose a significant burden on patients and healthcare systems. This study investigates the factors influencing the success of reconstructive surgery using flaps to treat these ulcers. The study retrospectively analyzed data from 111 flap surgeries performed between 2008 and 2020, focusing on flap survival at 40 days post-operation and identifying factors affecting flap failure. Key findings suggest that body mass index, congenital spinal cord injury, type of flap blood supply, and the use of methylene blue during surgery are associated with flap survival rates.

Study Duration

2008 to 2020

Participants

111 flaps on 76 patients

Evidence Level

Not specified

Key Findings

1
Higher body mass index is associated with increased risk of flap failure.
2
Congenital spinal cord injury increases the risk of flap failure compared to other causes of spinal cord injury.
3
The use of methylene blue to guide debridement of the wound is associated with a lower risk of flap failure.

Research Summary

This study examined the outcomes of 111 reconstructive flap operations for pressure ulcers, finding a 90% viability rate one month post-operation. Multivariable analysis identified higher BMI, congenital SCI, axial flap blood supply, and lack of methylene blue use as independent risk factors for flap failure. The study suggests optimizing BMI, careful flap selection, and utilizing methylene blue during surgery to improve flap survival rates.

Practical Implications

Optimize Patient BMI

Encourage weight management to achieve a normalized BMI before undergoing flap reconstruction for pressure ulcers.

Judicious Use of Methylene Blue

Incorporate methylene blue during debridement to clearly demarcate viable tissue and potentially improve flap survival.

Flap Selection

Consider random flaps, such as V-Y flaps, as a potentially preferable option over axial flaps in this patient population.

Study Limitations

1
Retrospective design and single-center approach
2
Lack of specified criteria for the use of methylene blue
3
The relatively small number of flaps in relation to the large number of variables

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