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Factores de riesgo basales para el fracaso del injerto de piel de espesor dividido: un estudio de cohorte
Eve Kinnunen1,2, Johanna Raukola2,3, Paavo Paajanen2,4
1Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 281, 00029 HUS, Helsinki Finland.
Resumen
La identificación de predictores de fracaso del injerto de piel de espesor dividido es crucial para la cicatrización de heridas. La enfermedad arterial periférica, la diabetes y la ubicación del pie aumentan el riesgo de fracaso, mientras que las heridas en el pecho y los traumatismos lo disminuyen.
Área de la Ciencia:
- Cirugía Plástica
- Cicatrización de Heridas
- Medicina Regenerativa
Sus antecedentes:
- El injerto de piel de espesor dividido es un procedimiento estándar para heridas complejas.
- Los predictores de fracaso del injerto de piel y cicatrización retardada requieren una mayor elucidación.
Objetivo del estudio:
- Identificar predictores basales de fracaso del injerto de piel de espesor dividido.
- Identificar predictores de cicatrización retardada de heridas después del injerto.
Principales métodos:
- Estudio retrospectivo unicéntrico de 1484 heridas en 1011 pacientes adultos sometidos a injerto de piel de espesor dividido (2009-2019).
- Fracaso del injerto definido como pérdida total o necesidad de reoperación.
- Se emplearon análisis de regresión logística y de riesgos proporcionales de Cox.
Principales resultados:
- El fracaso del injerto ocurrió en el 25,9% de los casos; se necesitó reoperación en el 20,0%.
- La enfermedad arterial periférica, la diabetes, los inmunosupresores y la ubicación del pie aumentaron significativamente el riesgo de fracaso del injerto.
- Los factores asociados con la cicatrización retardada incluyeron la ubicación del pie, una mayor duración de la herida, edema, enfermedad arterial periférica, uso de antipsicóticos y comorbilidades.
Conclusiones:
- Se identificaron varios factores de riesgo de malos resultados después del injerto de piel.
- La evaluación preoperatoria de las comorbilidades del paciente y la etiología de la herida es vital para optimizar la planificación y los resultados quirúrgicos.
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