Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction

Milcheski, Dimas André; Mendes, Rogério Rafael da Silva; Freitas, Fernando Ramos de; Zaninetti, Guilherme; Moneiro, Araldo Ayres; Gemperli, Rolf

doi:10.1590/0100-69912017006005

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Revista do Colégio Brasileiro de Cirurgiões

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Original Article • Rev. Col. Bras. Cir. 44 (06) • Nov-Dec 2017 • https://doi.org/10.1590/0100-69912017006005 copy

Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence.

Methods:

retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing.

Results:

in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up.

Conclusion:

the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.

Keywords:
Pressure Ulcer. Wounds and Injuries. Surgical Flaps. Surgery; Plastic.

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E-mail: revista@cbc.org.br

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[1] Mailing address: Dimas André Milcheski E-mail: drdimasandre@gmail.com/ dimas.milcheski@hc.fm.usp.br

	Age	Gender	Immobilization	Topography of the lesion
Patient 1	35	M	Paraplegia	Ischium and sacrum
Patient 2	28	M	Immobilization	Sacrum
Patient 3	75	F	Paraplegia	Ischium and trochanter
Patient 4	31	M	Paraplegia	Sacrum and bilateral ischium
Patient 5	37	F	Paraplegia	Sacrum and unilateral ischium
Patient 6	22	M	Immobilization	Bilateral trochanter
Patient 7	24	M	Paraplegia	Sacrum
Patient 8	69	M	Paraplegia	Bilateral trochanter
Patient 9	31	M	Paraplegia	Ischium unilateral
Patient 10	22	M	Tetraplegia	Sacrum
Patient 11	24	M	Paraplegia	Sacrum and unilateral ischium
Patient 12	40	M	Tetraplegia	Unilateral sacrum and trochanter
Patient 13	54	M	Paraplegia	Sacrum, trochanter and unilateral ischium
Patient 14	62	M	Paraplegia	Sacrum and unilateral ischium
Patient 15	24	M	Paraplegia	Unilateral ischium
Patient 16	30	M	Paraplegia	Unilateral trochanter
Patient 17	28	M	Paraplegia	Bilateral ischium
Patient 18	43	F	Tetraplegia	Sacrum
Patient 19	35	M	Paraplegia	Bilateral ischium
Patient 20	49	M	Paraplegia	Unilateral ischium

	Lesion	Flap
Patient 1	Ischium	Posterior thigh VY
Patient 2	Sacrum	Gluteus VY
Patient 3	Ischium and Unilateral Trochanter	Posterior thigh VY + fascia lata tensor
Patient 4	Bilateral Ischium	Bilateral posterior thigh VY
Patient 5	Sacrum	Bilateral gluteus VY
Patient 6	Trochanter Unilateral Trochanter	Fascia Lata tensor
Patient 7	Sacrum	Gluteus VY
Patient 8	Bilateral Ischium	Bilateral posterior thigh VY
Patient 9	Ischium	Posterior thigh VY
Patient 10	Sacrum	Gluteus VY
Patient 11	Sacrum	Bilateral gluteus VY
Patient 12	Sacrum	Gluteus VY
Patient 13	Sacrum	Gluteus VY
Patient 14	Ischium	Posterior thigh VY
Patient 15	Ischium	Posterior thigh VY
Patient 16	Unilateral Trocanter	Fascia Lata tensor
Patient 17	Bilateral Ischium	Bilateral posterior thigh VY
Patient 18	Sacrum	Gluteus VY
Patient 19	Bilateral Ischium	Bilateral posterior thigh VY
Patient 20	Ischium	Posterior thigh VY

	Osteomyelitis	Complications	Hospitalization (days)	Follow-up (months)	Stable covering (1 month)
Patient 1	Yes	No	4	18	Yes
Patient 2	No	Dehiscence	2	16	Yes
Patient 3	No	No	2	15	Yes
Patient 4	Yes	No	4	14	Yes
Patient 5	No	No	4	14	Yes
Patient 6	Yes	No	4	12	Yes
Patient 7	No	Hematoma	4	12	Yes
Patient 8	Yes	No	4	11	Yes
Patient 9	No	No	4	10	Yes
Patient 10	Yes	No	5	9	Yes
Patient 11	No	No	6	9	Yes
Patient 12	No	No	4	8	Yes
Patient 13	No	No	3	7	Yes
Patient 14	No	No	6	6	Yes
Patient 15	No	No	3	6	Yes
Patient 16	No	No	6	4	Yes
Patient 17	No	Dehiscence	2	4	Yes
Patient 18	No	Dehiscence	2	3	Yes
Patient 19	No	No	2	2	Yes
Patient 20	No	No	2	2	Yes