An Experience of Early Debridement and One-stage Flap Reconstruction of Decubitus Ulcers in a Tertiary Hospital.

Pritha Rakshit; Mainak Mallik; Saptarshi Bhattacharya

Volume : X, Issue : IV, April - 2020

An Experience of Early Debridement and One-stage Flap Reconstruction of Decubitus Ulcers in a Tertiary Hospital.

Pritha Rakshit, Mainak Mallik, Saptarshi Bhattacharya

Abstract :

Introduction: Decubitus ulcers are difficult entities present in long term institutionalized patients due to various etiopathologies resulting in prolonged immobilization and non–ambulation. These require a multidisciplinary approach, proper nursing and care giving. Deeper ulcers entail proper surgical deidement and coverage of the defect areas with a vascular and pliable tissue cover often in stages. Early surgical intervention for such lesions promote rapid wound healing, lesser period of hospital stay and reduced costs but only in selected cases where the patients are expected to ambulate early. Aims and objectives: This retrospective descriptive non–randomized purposive study over six months at a Tertiary hospital in eastern India aimed at execution of one–stage reconstructive surgeries in Grades II, III and IV decubitus ulcers when the patients were expected to ambulate early, documenting the technical aspects of the surgical procedures, the post–operative events and complications and wound healing on follow up. Methodology: Patients were selected based on the defects to be reconstructed and expectation to ambulate early, the pre operative work up and anesthesia check up were done, general conditions optimised and operated. Planning in reverse was done and the true defects of pressure ulcers defined after complete excision (extended bursectomy with a pseudo tumor approach) and the flaps were harvested, inset given and donor sites managed accordingly. Post–operatively the flaps were monitored clinically, the complications and issues addressed, dressings changed on frequent intervals and results interpreted. After discharge, they were followed up at regular intervals. Results: Out of 10 flaps in 10 cases (5 sacral, 3 trochanteric and 2 ischial pressure sores), all flaps survived (with marginal necrosis in 2 flaps). The mean size of the defects was 5.5 x 3.3 x 2.1 cm (length, eadth and depth respectively). The mean operative time was 3 hours and mean post–operative hospital stay was 6 days. Sacral pressure sore defects were reconstructed with cutaneous single or double rotation flaps with or without intervening gluteal muscle transposition, trochanteric ones with myocutaneous Tensor fascia lata flaps transposed or advanced in V–Y fashion and ischial ones with cutaneous Dufourmental or rotation advancement flaps with or without muscle cover. The wounds healed at a mean post–operative period of 21 days, suture removal being done at a mean period of 12 days and 60% of the patients could ambulate with support early within 2 weeks post–operatively. There was no recurrence of pressure sores at a mean follow up period of 3 months. Conclusion: In cases of decubitus ulcers (in patients who are expected to ambulate early), presenting with deeper lesions not amenable to heal quickly conservatively, early deidement after optimising general conditions and one–stage reconstruction may be contemplated as a safe and definitive procedure.