Prevalence and Risk Factors of Pressure Ulcers in Bedbound Diabetic vs. Non-diabetic Patients in a Lower-Middle-Income Country.

Introduction Pressure ulcers, also known as bedsores, are a significant concern for bedridden individuals, presenting both physical and socioeconomic challenges. Factors such as prolonged immobility, chronic medical conditions, and poor nutrition contribute to their development. Despite extensive research in some regions, studies comparing diabetic and non-diabetic populations remain limited, particularly in low-income settings. This study aimed to investigate the risk factors and frequency of pressure ulcers among bedridden patients, addressing this gap in understanding and guiding targeted interventions. Materials and methods A cross-sectional study was conducted across four government hospitals in Peshawar, Pakistan. A total of 388 bedridden patients with pressure ulcers were included, and data were collected through a questionnaire. The questionnaire covered demographics, comorbidities, duration of bedbound status, BMI, and caregivers' awareness of pressure ulcer care. Data analysis was performed using SPSS version 22.0 (Armonk, NY: IBM Corp.), with qualitative data presented as frequencies and percentages and quantitative data as mean and standard deviation. Chi-square tests were utilized for significance, with p<0.05 considered significant. Results Of the 388 patients analyzed, 230 (59.3%) were diabetic, highlighting the prevalence of diabetes among pressure ulcer cases. The majority of diabetic patients with ulcers were over 41 years old, and 293 (75.5%) had comorbidities. Surgical intervention was the primary cause of ulcers in 213 (54.8%) cases, followed by stroke in 77 (19.8%) cases. Notably, 252 (65%) of caregivers exhibited inadequate knowledge regarding ulcer care. Stage II ulcers were prevalent in both diabetic and non-diabetic cohorts. Conclusions Pressure ulcers are poorly controlled complications observed in bedridden individuals, highlighting a critical need for comprehensive preventive measures and caregiver education to alleviate the burden of pressure ulcers, especially in diabetic patients. Factors such as prolonged immobility, surgical interventions, and insufficient caregiver knowledge contribute to the development of pressure ulcers. Understanding these complexities is essential for implementing effective care approaches and mitigating the impact of pressure ulcers.

Unveiling denture-induced oral lesions: A comprehensive study on classification and pain assessment.

BACKGROUND: Denture-induced oral Lesions (DIOLs) often manifests shortly after the placement or adjustment of new or realigned dentures, frequently resulting in severe pain and discomfort. OBJECTIVES: This study aimed to classify DIOLs placing a particular emphasis on assessing the associated pain. METHODS: A prospective case study was conducted involving 126 patients who were fitted with a total of 193 dentures of various types at the Hadassah School of Dental Medicine. All patients underwent comprehensive intra-oral examinations within 1-8 weeks following denture delivery, completed symptom questionnaires and had their medical records reviewed. Key variables documented included age, gender, overall health status, denture type, and a detailed description of the DIOLs. The description encompassed factors such as lesion location, shape, colour, size, border characteristics, ulcerative appearance, membrane coverage, 3D morphology (elevated, immersed and flat) and patient-reported Verbal Pain Score (VPS) when touching the DIOLs, when wearing the denture, and when not wearing the denture. RESULTS: Notably, 25.4% of denture wearers required no adjustments, while 14.4% necessitated more than three revisions. A majority (71.8%) of DIOLs cases were associated with mandibular complete dentures, primarily situated on the alveolar ridge. The mean VPS indicated a pain intensity of 7 ± 2.1, with temporary dentures in both jaws causing the most discomfort. Implant-supported overdentures were particularly painful when placed in the mandible. Additionally, VPS scores were higher among older individuals and those with prior prosthetic experiences. A significant correlation was observed between pain intensity and presence of chronic health condition (0.036). CONCLUSIONS: This study revealed distinct characteristics of DIOLs and highlighted the multifactorial nature of pain experienced following the development of DIOLs. Insights into the influence of patient and denture characteristics on DIOLs and pain intensity can guide healthcare professionals in optimising patient comfort and satisfaction.

Getting up With Lateral Thinking.

Introduction: Falls in the community can have major impacts on patient lives. There can be long lasting physical and psychological consequences of a fall and subsequent long lie. The annual burden to ambulance services responding to falls at home is high. Affordable devices to help people get up from the floor, or reduce the risk of a long lie, would be useful and widely applicable. Case report: We present the case of 2 families who successfully used an air mattress and a bath lift to get the fallen person up off the floor following a fall, when they had previously called an ambulance. This has reduced their dependence on the ambulance service and has improved their confidence following falls. Discussion/conclusion: Affordable devices such as air mattresses can help people off the floor following a fall and prevent long lies as well as reduce the number of ambulance call outs.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis.

BACKGROUND: Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. METHODS: This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). RESULTS: A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). CONCLUSION: This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis.

BACKGROUND: Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. METHODS: This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). RESULTS: A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). CONCLUSION: This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.

Multivariate analysis and nursing intervention strategies for intraoperative pressure ulcers in patients undergoing craniocerebral microsurgery.

OBJECTIVE: This study aimed to investigate the various influencing factors for intraoperative pressure sores in patients with craniocerebral microsurgery and provide nursing intervention strategies for surgical pressure sores in a clinical operating room. METHODS: This was a case-control study on 2157 patients who underwent craniocerebral microsurgery in the craniocerebral department of the hospital between November 2021 and November 2022. Of these, 62 patients with intraoperative pressure sores were compared with 248 patients without pressure sores during the same period using a 1:4 case-control method. A logistic regression model was used to analyze the effect of possible factors on pressure sores in an operating room. RESULTS: The incidence of pressure sores in craniocerebral microsurgery was 2.87%. The logistic regression analysis showed that skin at the pressure site [odds ratio (OR) = 1.759, 95% confidence interval (CI): 1.137-2.721], surgical position (OR = 1.727, 95% CI: 1.338-2.228), intraoperative body temperature (OR = 2.229, 95% CI: 1.229-4.042), and surgical time (OR = 2.009, 95% CI: 1.221-3.303) were independent factors for the occurrence of intraoperative pressure sores. CONCLUSIONS: The high-risk factors for pressure sores in craniocerebral microsurgery included fasting time, surgical position, intraoperative temperature, and skin at the pressure site. Targeted attention and protection had a positive effect in preventing intraoperative pressure sores in patients who underwent craniocerebral microsurgery.

Mesenchymal Stromal Cell Healing Outcomes in Clinical and Pre-Clinical Models to Treat Pressure Ulcers: A Systematic Review.

BACKGROUND: Despite numerous measures used to prevent pressure ulcers, their growing prevalence in recent years is expected to continue as the population ages. This review aims to report the outcomes of the regenerative potential of MSCs in treating pressure ulcers, assessing the effectiveness of MSCs in treating pressure ulcers. METHODS: A computerized search for articles on animal models that use MSCs as primary therapy to treat pressure ulcers, published from conception to present, was conducted using PubMed, MEDLINE, Embase, and CINAHL. Our search yielded 52 articles, narrowed to 44 after excluding duplicates. RESULTS: Out of 52 articles collected from four databases, 11 met the inclusion criteria. A total of 11 articles published between 2008 and 2020 met the inclusion criteria. Eight studies were observational descriptive papers in animal models, and three were prospective. Six studies used autologous MSCs, while five used allogenic MSCs. Three studies were conducted in humans, and the remaining eight were conducted in animals. The most common method of cell delivery was an intradermal injection in the margins of the ulcer. All studies reported positive results, including improved wound healing, reduced inflammation, and improved tissue regeneration. CONCLUSIONS: MSCs have shown promising results in treating pressure ulcers in animal and clinical trials. The combination of MSCs and scaffold materials has also been studied and found to be effective in wound healing. A standardized human wound model has been proposed further to investigate the efficacy of cell-based therapies for chronic wounds. However, more research is needed to determine the best quantity of cells to apply for pressure ulcers and to ensure the safety and efficacy of these treatments in clinical settings.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft.

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

Single-session repair of multiple pressure ulcers in non-ambulatory patients.

OBJECTIVE: Pressure ulcers (PUs) are highly prevalent and challenging wounds. In this study, patients with either tetraplegia or paraplegia, all of whom had multiple grade 4 PUs and who underwent single-session surgical treatment were included. In order to increase the mobility of the musculocutaneous flap, the gluteus maximus muscle, which cannot be used by immobile patients, was detached and inserted into the flap. METHOD: This was a retrospective case series and all PUs were reconstructed within the same surgical session. RESULTS: A total of nine patients participated in the study, all of whom were male. Mean age was 33 years (range: 20-42 years). Mean follow-up period was 14.3 months (range: 9-24 months). All patients had a successful single-session repair of all PUs. Total or partial flap losses were not observed. Mean and total number of reconstructed PUs were 2.55 and 23, respectively. The mean area of reconstructed open wounds per patient was 174.6cm2 and the mean operation duration was 253 minutes. The level of blood loss was acceptable as the decrease in haemoglobin levels was not more than 2g/dl for each patient. CONCLUSION: Multiple PUs can be repaired in one session using gluteus maximus musculocutaneous flaps in immobile patients. Based on the fact that the gluteus maximus is an essential muscle for ambulation, our approach can only be used in the treatment of patients with irreversible paraplegia or tetraplegia. When all prerequsities are met, the amount of blood loss and operation duration are acceptable, and returning the patient to a wound-free state can be achieved more quickly compared to multi-session repairs. Air-fluidised beds are vital tools for accomplishing single session repairs of multiple PUs. The data shows that the approach is safe and can be used in patients with multiple PUs.

Characteristics and clinical course of patients referred to the NST.

Background and aims: The nutrition support team (NST) comprises doctors, nutritionists, pharmacists, and nurses who provide intensive nutritional treatment designed for each patient by evaluating their nutritional status of hospitalized patients. This study aimed to identify the clinical characteristics of patients referred to the NST among those admitted to a tertiary hospital and to understand the factors affecting their clinical course and changes in pressure sore grades. Methods: This study included 1,171 adult patients aged 18 years or older referred to the NST at a tertiary hospital in a metropolitan city between 1 January 2019 and 31 December 2020. Patients were divided into five age groups, neuro department and non-neuro department, those treated in the intensive care unit (ICU), and those not treated in the ICU. Patients were also compared based on the presence of pressure sores at the time of NST referral and changes in pressure sore grades at the first time of NST referral and discharge (improved pressure sores, no change in pressure sores, and aggravated pressure sores). In addition, this study examined the factors affecting changes in pressure sore grades. Results: As age increased, the proportion of both low albumin levels and pressure sores significantly increased (p < 0.001), and the neuro department showed a significantly lower proportion of low albumin levels and pressure sores (p < 0.001). The proportion of patients with pressure sores was higher (64.9%), and this patient group showed significantly higher rates of low albumin levels (p < 0.001) and treatment in the ICU (p < 0.001). The group with aggravated pressure sore grades had a significantly higher proportion of patients in the surgery department (p = 0.009) and those treated in the ICU (p < 0.001). Admission to the surgery department was a factor that aggravated the grade of pressure sores [adjusted odds ratio (aOR) = 1.985, 95% confidence interval (CI) = 1.168-3.371]. When patients were not treated in the ICU, the grade of the pressure sores was less likely to worsen (aOR = 0.364, 95% CI = 0.217-0.609). Conclusion: Pressure sores and low albumin levels are closely related, and the risk of developing and aggravating pressure sores is particularly high in patients in the surgery department and those receiving ICU treatment. Therefore, it is necessary to actively implement NST referral to ensure that overall nutrition, including albumin, is well supplied, especially for patients in the surgery department and treated in the ICU, as they are at high risk of pressure sore development and aggravation. Moreover, since low albumin levels frequently occur in elderly patients, it is necessary to consider including the elderly in the indications for referral to the NST.

Nutritional status in patients with advanced-stage multiple sclerosis.

INTRODUCTION: Motor and swallowing dysfunctions in multiple sclerosis (MS) unbalance calorie intake and energy expenditure, modifying nutritional status. Only one study has described nutritional status in MS patients at early disease stages (median Expanded Disability Status Scale [EDSS] = 3), but this has never been assessed in the most severe cases. The goal of the present study was to describe nutritional status in advanced-stage MS. METHODS: The study was a non-interventional retrospective analysis of a prospective registry. We reviewed medical files of consecutive MS patients admitted for annual follow-up in a physical and rehabilitation medicine unit between May 2016 and October 2018. Malnutrition for frail people, according to the French Health Authority (Haute Autorité de Santé [HAS]) definition, was our composite primary outcome criterion: body mass index (BMI) <21 kg/m2 and/or albumin<35 g/L. First, we performed a descriptive analysis of the nutritional status. Second, we studied the association between malnutrition and MS characteristics in univariate and multivariate analyses. RESULTS: A total of 163 patients with median EDSS = 8 [7; 8.5] were included. Ninety-three patients (57%) met HAS malnutrition criteria (36% with albumin <35 g/L, 31% with BMI <21 kg/m2 and 10% with both). Malnutrition was associated in univariate analysis with MS severity (EDSS ≥8.5, p = 0.0003), primary progressive type of MS (p = 0.01) and swallowing disorders (p = 0.002). Multivariate analysis showed that low disability status (EDSS <7) was the only independent (protective) factor associated with malnutrition (OR = 0.2, p = 0.03). CONCLUSIONS: Malnutrition is frequent in advanced stages of MS and is probably a key point for therapeutics, which has never been demonstrated previously. A standardized evaluation should be developed to improve nutritional therapeutic strategies in this population.

[Pressure sores-A multilayered challenge]. / Dekubitus ­ eine vielschichtige Herausforderung.

Pressure sores occur when soft tissue of the skin, subcutaneous fat tissue or musculature is exposed to pressure or friction over a long period of time, which leads to local ischemia with subsequent necrosis. All areas of the skin lying over bones with only a thin layer of soft tissue are predilection sites. In older patients the risk factors for the development of a pressure sore must be systematically documented at admission and during the course of the disease. Accordingly, the necessary prophylactic procedures must be initiated. The classification of the European Pressure Ulcer Advisory Panel (EPUAP) is used to describe a pressure sore. For the differential diagnosis, incontinence-associated dermatitis and a manifest peripheral artery occlusive disease must be excluded. The treatment consists of positioning procedures and local and systemic supportive wound treatment. In cases of deep pressure sores, coverage by plastic surgery can effectively accelerate healing. The multiprofessional geriatric team has the appropriate prerequisites for comprehensive treatment of pressure sores.

Short and long-term complications due to standard and extended prone position cycles in CoViD-19 patients.

OBJECTIVE: To investigate short and long-term complications due to standard (≤24 hours) and extended (>24 hours) prone position in COVID-19 patients. METHODS: Retrospective cohort study conducted in an Italian general intensive care unit. We enrolled patients on invasive mechanical ventilation and treated with prone positioning. We recorded short term complications from the data chart and long-term complications from the scheduled follow-up visit, three months after intensive care discharge. RESULTS: A total of 96 patients were included in the study. Median time for each prone positioning cycle (302 cycles) was equal to 18 (16-32) hours. In 37 (38%) patients at least one cycle of extended pronation was implemented. Patients with at least one pressure sore due to prone position were 38 (40%). Patients with pressure sores showed a statistically significative difference in intensive care length of stay, mechanical ventilation days, numbers of prone position cycles, total time spent in prone position and the use of extended prone position, compared to patients without pressure sores. All lesions were low grade. Cheekbones (18%) and chin (10%) were the most affected sites. Follow-up visit, scheduled three months after intensive care discharge, was possible in 58 patients. All patients were able to have all 12 muscle groups examined using theMedical Research Council scale examination. No patient reported sensory loss or presence of neuropathic pain for upper limbs. CONCLUSIONS: Extended prone position is feasible and might reduce the workload on healthcare workers without significant increase of major prone position related complications.

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016).

BACKGROUND: Patient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals. OBJECTIVES: To determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016. METHOD: Data were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register. RESULTS: A total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50-59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs. CONCLUSION: The study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.

The Risk Factors-Based Nursing Case Management Could Effectively Reduce the Incidence of Pressure Sores in Hospitalized Patients.

BACKGROUND: To explore the effects of risk factors-based nursing management on the occurrence of pressure sores in hospitalized patients. METHODS: From Jan 2018 to Jun 2018, 289 hospitalized patients were divided into pressure sores group [100] and control group [189] for retrospective analysis. Overall, 260 hospitalized patients from Jun 2018 to Dec 2018 were followed up for nursing intervention. Overall 130 patients received risk factors-based nursing case management were in the intervention group, whereas 130 patients who received routine nursing care were in the control group. The chi-square test and t-test were used to compare the count data and the measurement data between groups, respectively. RESULTS: Age, body weight and proportions of patients with impaired nutritional intake, diabetes or stroke in pressure sores group were higher than those in normal group (P<0.05). Hospital stay and operative time in pressure sores group was longer than those in normal group (P<0.05). The frequency of assistant activity in pressure sores group was significantly lower than that in control group (P<0.05).In addition, the score of uroclepsia in pressure sores group was lower than that in normal group (P<0.05). Patients in the intervention group showed lower risk for pressure sores and more satisfied than patients in control group (P<0.001). CONCLUSION: Advanced age, high body weight, diabetes and stroke, long hospital stay, long operative time, poor nutritional status and severe uroclepsia were independent risk factors of pressure sores. Risk factors-based nursing case management can effectively reduce the occurrence and risk of pressure sores for hospitalized patients.

Successful reconstruction of ischial pressure sores with inferior gluteal artery descending branch perforator flap.

BACKGROUND: Ischial pressure sores often recur, the surgical choice often troubled the surgeon, because surgery repair should consider future reconstructive procedures. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores by using an inferior gluteal artery of the descending branch perforator flap. METHODS: A study involving patients suffering from ischial pressure sores was performed from March 2016 to August 2020. Patients with large defects, for which direct closure was not possible, underwent reconstructive surgery using an inferior gluteal artery descending branch perforator flap. Collected data included age, diabetes, wound culture, size of the wound, whether or not negative pressure therapy was received, operative time, intraoperative blood loss, and postoperative complications. Patients were followed up through outpatient visits or by telephone. RESULTS: Five patients with ischial pressure sores (four primary and one recurrent) underwent reconstructive surgery with inferior gluteal artery descending branch perforator flap. One patient received colostomy and wound negative pressure therapy before lesion reconstruction. All patients successfully recovered without postoperative complications. The follow-up period ranged from 4 to 31 months. No wound disruption or recurrence was recorded. CONCLUSIONS: Inferior gluteal artery descending branch perforator flap treatment of ischial pressure sores is a simple and feasible method for preserving the inferior gluteal artery's main vascular perforators and could be used as a future surgical option.

The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes.

BACKGROUND: The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author's experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap. METHODS: The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients' demographic data, operative details, and postoperative complications were evaluated. RESULTS: Between October 2018 and December 2019, 10 consecutive patients (age range, 13-45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed. CONCLUSIONS: The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

Choices for treatment of pressure sores in different parts of buttocks / 中华显微外科杂志

Objective:To explore the treatment of pressure sores in different parts of the buttocks.Methods:From May, 2005 to March, 2020, 170 (157 patients) pressure sores in different parts of buttocks were treated. Eighty-two pressure sores located at sacrococcyx, 52 at ischial tuberosity, 24 at greater trochanter (without hip joint exposure) and 12 at femoral greater trochanter with exposure of the hip joint. Flaps were used to repair the pressure sores. ①Seventy-one sacrococcygeal pressure sores were repaired by the gluteal epithelial neurovascular flap; ②10 (10 patients) sacrococcygeal and 42 (36 patients) sciatic tubercle pressure sores were repaired by the posterior femoral neurovascular flap; ③24(24 patients) femoral trochanter pressure sores and 1(1 patient) sacrococcygeal pressure sore were repaired by the tensor fascia lata myocutaneous flap; ④2 (2 patients) sciatic tubercle pressure sores were repaired by the gracilis myocutaneous flap; ⑤12 (10 patients) femoral trochanter pressure sores were with hip joint exposure treated with hip joint amputation; ⑥8 (8 patients) pressure sores at ischial tuberosity were treated with VSD. The pressure sores were measured at 5.0 cm×8.0 cm-15.0 cm×30.0 cm, and the flaps were sized 10.0 cm×12.0 cm-17.0 cm×32.0 cm. The follow-up was conducted in 2 methods: visit of outpatient clinic by patients and WeChat distanced interview by medical staff.Results:The gluteal epithelial neurovascular flaps, tensor fasciae lata flaps, gracilis myocutaneous flaps and posterior femoral neurovascular flaps all survived; 4 of 10 posterior femoral neurovascular flaps had partial necrosis and healed after dressing change. A total of 139 patients were treated by flap repair, of which 136 pressure sores healed, except 1 sacrococcygeal pressure sore and 1 femoral greater trochanter pressure sore did not heal because the patient was in old age, long-term hypoproteinaemia and anaemia, and 1 ischial tubercle pressure sore failed to heal due to osteomyelitis osteomyelitis. Ten pressure sores at femoral greater trochanter decubitus with hip joint exposure treated by hip joint amputation and 8 pressure sores at ischial tubercle decubitus treated by simple insertion of VSD were all healed. The follow-up period was 0.5-15.0 years, 7.5 years in average. The results of follow-up showed that pressure sores healed without recurrence in 154 patients, but failed to heal in 3 patients.Conclusion:The gluteal epithelial neurotrophic vascular flap has reliable blood supply and is simple to harvest, and it is a good flap to repair sacrococcygeal pressure sores. The tensor fascia lata myocutaneous flap has reliable blood supply and is simple to harvest, hence it is a good flap to repair greater trochanteric pressure sores. Transposition of the posterior femoral cutaneous nerve nutrient vessel flap or the V-Y advancement flap is simple and effective in repair of the sciatic tuberosity pressure sores. However, it is not recommended to apply the transposition of posterior femoral cutaneous nerve nutrient vessel flap in repair of the sacrococcygobtaineal pressure sore, because it would cause a necrosis at the distal part of the flap. When a greater trochanteric pressure sore coexists with an expose of hip joint, the hip joint can be dissected. For the pressure sore at ischial tuberosity, and if there is a small wound with a large internal cavity, it can be treated with simple insertion of VSD.

Perioral pressure ulcers in patients with COVID-19 requiring invasive mechanical ventilation.

BACKGROUND: Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting. METHODS: A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality. RESULTS: Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days. CONCLUSIONS: The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication.Level of evidence: Level IV, risk/prognostic study.

Retrospective Cohort Observational Study on the Single Best Perforator-Based Pacman Flap in the Reconstruction of Stage IV Sacral Region Pressure Ulcers.

Introduction Single best perforator-based Pacman flap (SBPBPF) fortifies the advancement and transposition flap biogeometry principles with robust blood supply of perforator flaps to provide cover for the sacral pressure sore of any dimension. This article describes the biogeometry and technique of raising the SBPBPF. Aim To assess the outcomes of reconstruction of stage IV sacral pressure sore using the SBPBPF. Materials and Methods A preliminary cadaver study was done in 24 gluteal specimens in fresh cadavers to determine the anatomical details of perforators of the perisacral region. From 2015 to 2017, 42 myelopathic patients (40 males and 2 females; quadriparetic n = 2 and paraplegic/paraparetic n = 40) underwent SBPBPF reconstruction of stage IV sacral pressure sore. Their documents were analyzed in this retrospective study. All were followed-up for an average period of 12.5 months. Results Cadaver study revealed significant perforators arising from seven different source vessels in the perisacral region. In the clinical study, average size of the paddle harvested was 168 cm 2 on a single best perforator. On an average, the size of the single best perforator harvested with the flap was 1.5 mm. None had early failures of flaps. Thirty-nine patients had well-settled flaps at the end of follow-up period except three (7%) who developed late recurrence due to loss of compliance with offloading instructions. Two experienced mild collections (flap complication rate was 4.76%) in the immediate postoperative period that healed uneventfully. The overall complication rate was 11.9%. Conclusion SBPBPF is an excellent addendum to reconstructive tool for stage IV sacral pressure sores.