A retrospective, descriptive study of sacral ulcer flap coverage in nonambulatory patients with hypoalbuminemia

Deep sacral pressure ulcers in nonambulatory hospitalized patients often are managed using surgical flaps. Reports about the effects of protein status on postoperative healing are inconsistent but surgery often is delayed until serum albumin levels normalize. Considering these conflicting data and the potential effects of delayed closure, the protocol at a Philippine national university hospital was changed to allow for early surgical reconstruction of sacral ulcers in hypoalbuminemic nonambulatory patients. A retrospective chart review was conducted to evaluate clinical outcomes of 16 nonambulatory patients (10 men, 6 women; average age 54 years, range 18 to 74) with moderate to severe hypoalbuminemia who underwent flap surgery for coverage of their Stage III or Stage IV sacral ulcers within a protocol of interdisciplinary care. Outcomes measured included the number of surgeries needed for coverage and wound complications encountered. Patient average albumin level before flap coverage was 21 g/L (range: 8 to 30 g/L), average sacral ulcer size was 10 cm x 10 cm, patients underwent an average of 2.56 procedures to achieve coverage, and average follow-up period was 11.25 months (range: 3 to 33 months, SD +/- 10.4) after surgical closure. Of the 16 flaps, 15 (93.75%) were healed on final follow-up. Six patients (37.5%) had wound-related complications with more complications observed in the younger (<54 years old) patient group (r = 0.516; P = 0.039). Results suggest that with a system of interdisciplinary care and collaboration, sacral ulcer flap surgery can be performed in patients with moderate to severe hypoalbuminemia.