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Surgical treatment of pressure injuries in children: A multicentre experience
Marco Pignatti1,2, Salvatore D'Arpa3, Nathalie Roche4
1Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.
Insights
Surgical treatment for severe pediatric pressure injuries (PI) is rare but effective. Pedicled flaps show high success rates in treating these challenging cases, with low recurrence rates observed.
Area of Science:
- Pediatric Plastic Surgery
- Wound Management
- Reconstructive Surgery
Background:
- Pressure injuries (PI) are uncommon in children, with prevalence varying by care setting.
- Reduced mobility and medical devices are common contributing factors in pediatric PI.
- While most pediatric PIs heal spontaneously, severe or refractory cases may require surgical intervention.
Purpose of the Study:
- To evaluate the surgical management of severe (Stage 3 or 4) pressure injuries in pediatric patients.
- To report the outcomes of reconstructive surgery for pediatric pressure injuries across multiple European centers.
- To assess the efficacy and recurrence rates of surgical interventions for pediatric pressure injuries.
Main Methods:
- Retrospective review of clinical histories from four European Plastic Surgery Centers.
- Inclusion of pediatric patients (ages 1-17) with Stage 3 or 4 pressure injuries.
- Surgical coverage using pedicled or free flaps after debridement.
Main Results:
- Eighteen pediatric patients with severe pressure injuries were successfully treated.
- Seventeen patients received pedicled flaps, and one received a free flap.
- Low recurrence rates were observed, with only two patients experiencing true recurrences requiring re-treatment.
Conclusions:
- Surgical treatment for pediatric pressure injuries is infrequent but successful.
- Pedicled flaps are a highly effective method for reconstructing pediatric pressure injuries.
- Recurrence rates for surgically treated pediatric pressure injuries are low, contrary to some literature.
Abstract:
Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1-17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
