Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study

Area of Science:

• Plastic surgery
• Wound healing
• Reconstructive surgery

Background:

• Pressure ulcers present significant challenges for patients and healthcare systems.
• Research has primarily focused on pressure ulcer recurrence, with limited data on flap survival post-reconstruction.
• This study aims to describe patient demographics and analyze factors affecting flap survival in pressure ulcer treatment.

Purpose of the Study:

• To describe the characteristics of patients undergoing flap surgery for pressure ulcers.
• To identify factors associated with flap survival after reconstructive surgery for pressure ulcers.
• To provide insights for improving surgical outcomes in pressure ulcer management.

Main Methods:

• A retrospective analysis of 111 flap operations performed between 2008 and 2020.
• Flap survival was assessed at 40 days post-surgery.
• Multivariable logistic regression analyzed patient demographics, ulcer characteristics, and surgical variables impacting flap survival.

Main Results:

• The overall flap survival rate was 90% across 111 flaps (70% random, 30% axial/perforator-based).
• Factors associated with flap failure included higher body mass index, congenital spinal cord injury, flap blood supply type, and use of methylene blue.
• Fasciocutaneous flaps constituted 49% of cases, with a mean BMI of 25.

Conclusions:

• Optimizing body mass index and utilizing methylene blue for wound debridement can enhance flap survival rates.
• The findings suggest that random flaps may offer better survival outcomes compared to axial flaps in this patient cohort.
• This research provides actionable insights for modifying surgical techniques to improve reconstructive outcomes for pressure ulcers.