eMedicine Specialties > Plastic Surgery > Pressure Ulcers

Pressure Ulcers, Surgical Treatment and Principles: Follow-up

Author: Bradon J Wilhelmi, MD, Endowed Leonard Weiner, MD, Professor and Chief of Division of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Coauthor(s): Michael Neumeister, MD, FRCSC, FACS, Program Director, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2008

Outcome and Prognosis

With the highest complication rate of all procedures performed, pressure sore reconstruction is perhaps the most complex challenge to plastic surgeons. Treatment of patients with pressure sores involves several considerations to minimize the risk of adverse outcomes of the reconstruction. Patients must be meticulously and compulsively prepared preoperatively, with nutritional deficiency, anemia, spasms, and coexisting urinary infection corrected. Patients must have adequate social resources, including pressure-release beds, wheelchair mattresses, and a compliant attitude to prevent recurrence. Intraoperatively, technical points of pressure sore reconstruction must be followed stringently to minimize the risk of complications. The postoperative regimen for the transition from flat bed rest to sitting and from weight-shifting into and out of the wheelchair in the return to daily living must be strict and careful.

Even with close adherence to the above stated guidelines, pressure sore recurrence rates are high. When caring for patients with chronic pressure sores, flap procedures must be planned carefully and social resources must be provided assiduously to reduce the high risk of adverse outcomes in this complication-prone population.

Future and Controversies

Wound healing factors that promote spontaneous wound closure of pressure ulcers have been identified. Platelets play an important role in the inflammatory phase of wound healing by providing hemostasis and releasing growth factors known to accelerate wound healing. Atri et al reported their success in augmenting spontaneous wound healing with platelet-derived growth factors for 23 subjects in whom initial treatment with Silvadene failed.8 Later, Robson et al and Mustoe and colleagues found recombinant platelet-derived growth factor BB in concentrations of 100 mcg/mL to effect clinical wound healing in a phase II study of stage 3 and 4 pressure ulcers.9,10

The cost to treat patients with these growth factors is presently significant. However, in the future, these nonoperative measures may be involved in the treatment of pressure ulcers, especially for patients who are not suitable for surgery because of coexisting morbidities.

 


More on Pressure Ulcers, Surgical Treatment and Principles

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References
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Further Reading

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Keywords

pressure ulcer, decubitus ulcer, bed sore, pressure sore, nonhealing wound, non-healing wound, wound healing complication, wound-healing complication, pressure ischemia, paraplegia, quadriplegia, spina bifida, immobilization, multiple sclerosis, MS, Marjolin ulcers, pressure sore reconstruction, flap procedures, chronic wound, pressure sore carcinoma

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Contributor Information and Disclosures

Author

Bradon J Wilhelmi, MD, Endowed Leonard Weiner, MD, Professor and Chief of Division of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Clinical Anatomists, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association for Surgical Education, Plastic Surgery Research Council, and Wound Healing Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Neumeister, MD, FRCSC, FACS, Program Director, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Southern Illinois University School of Medicine
Michael Neumeister, MD, FRCSC, FACS is a member of the following medical societies: American Academy of Dermatology, American Association for Hand Surgery, American Burn Association, American Medical Association, American Society of Plastic Surgeons, Canadian Medical Association, College of Physicians and Surgeons of Alberta, College of Physicians and Surgeons of Ontario, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Albert E Cram, MD, FACS, Professor Emeritus, Departments of Surgery, Otolaryngology Head & Neck Surgery and Orthopedic Surgery, University of Iowa College of Medicine; Consulting Staff, Iowa City Plastic Surgery
Albert E Cram, MD, FACS is a member of the following medical societies: American Association of Tissue Banks, American Burn Association, American College of Surgeons, American Heart Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS, Professor of Surgery, Emeritus, Stanford University Medical Center
Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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