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Stage IV Perineal Pressure Ulcers in Immobile Patients Treated With Surgical Flap Closure Augmented With
Dinakar Golla1, Dorothy H Kurtz Phelan2
1Dinakar Plastic Surgery, Pittsburgh, PA.
Introduction:
Surgical closure of late-stage pressure ulcers (PUs) poses challenges in the immobilized population due to the high rate of complications, including infection, dehiscence, and recurrence. Muscle flap closure is the standard treatment for chronic, late-stage (stage 4) PUs, characterized by the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel as full-thickness tissue loss with exposure of bone, tendon, or muscle.
Objective:
The aim of this study is to evaluate the outcomes associated with the use of a cryopreserved placental membrane containing viable cells (vCPM) graft for the augmentation of surgical flap closure in nonhealing perineal ulcers.
Materials And Methods:
Four paraplegic patients (2 men, 2 women; average age, 61 years; range, 44-77 years) with stage IV PUs (ischial, gluteal, and sacral areas) with a mean duration of 4 years (range, 0.5-10 years) received muscle flap closure augmented with vCPM. Following surgical debridement, vCPM was placed between the wound bed and muscle flap closure prior to skin closure. Patients were kept offloaded in fluid-air beds for 6 weeks followed by a gradual return to mobilization.
Results:
All 4 patients achieved complete wound closure in an average of 7 weeks (range, 6-8 weeks) without complications or recurrence. All patients demonstrated complete take of the muscle flap and maintained their closed wounds for an average follow-up of 12 months.
Conclusions:
Preliminary clinical results indicate vCPM supports surgical wound closure of chronic perineal PUs in immobile, high-risk patients. In an effort to decrease postoperative recovery time and reduce complications, vCPM may be beneficial for patients undergoing perineal muscle flap closure.
Insights
Cryopreserved placental membrane (vCPM) with muscle flap closure successfully healed chronic pressure ulcers in immobile patients. This innovative approach reduced complications and recovery time for stage IV wounds.
Area of Science:
- Regenerative Medicine
- Wound Healing
- Tissue Engineering
Background:
- Surgical closure of late-stage pressure ulcers (PUs) is challenging in immobilized patients, often leading to complications like infection and recurrence.
- Muscle flap closure is the standard for stage IV PUs, involving full-thickness tissue loss exposing underlying structures.
Purpose of the Study:
- To evaluate cryopreserved placental membrane with viable cells (vCPM) as an augmentation for surgical flap closure in nonhealing perineal ulcers.
- To assess the efficacy of vCPM in improving outcomes for high-risk, immobile patients with chronic stage IV PUs.
Main Methods:
- Four paraplegic patients with stage IV perineal PUs received muscle flap closure augmented with vCPM.
- vCPM was applied between the wound bed and muscle flap after debridement, prior to skin closure.
- Patients underwent a 6-week offloading period followed by gradual mobilization.
Main Results:
- All four patients achieved complete wound closure within an average of 7 weeks.
- No complications or recurrence were observed during an average 12-month follow-up period.
- Complete take of the muscle flap and sustained wound closure were noted in all cases.
Conclusions:
- Preliminary findings suggest vCPM supports surgical closure of chronic perineal PUs in immobile, high-risk individuals.
- vCPM may reduce postoperative recovery time and complications associated with perineal muscle flap closure.
- Further research is warranted to confirm the benefits of vCPM in managing complex wounds.
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