title: Magnetic resonance imaging of nonhealing pressure ulcers and myocutaneous flaps.
abstract: OBJECTIVE
  To evaluate the use of magnetic resonance imaging (MRI) in making clinical decisions when assessing nonhealing pressure ulcers and nonhealing myocutaneous flaps for the presence of an abscess, osteomyelitis, sinus tracts, and fluid collections.
  
  
  METHODS
  Retrospective review of patient charts and radiographic studies.
  
  
  METHODS
  Regional spinal cord injury center.
  
  
  METHODS
  Twelve patients who had MRI as part of their evaluation for a nonhealing pressure ulcer or myocutaneous flap.
  
  
  RESULTS
  Seven patients had MRI for preoperative evaluation, four with a previous flap that had recurrent breakdown and three with a new grade III or IV ulcer. Five patients had MRI for postoperative evaluation of myocutaneous flaps with delayed healing. MRI was useful in identifying osteomyelitis in three patients and sinus tracts that required surgical revision in six patients. MRI was also used in two patients to assess the size of fluid collections postoperatively in determining whether the patients should be mobilized after surgery. These chronic nonhealing wounds resulted in multiple admissions and lengthy hospital stays and required multiple surgical revisions. Patients who did poorly with healing or had repeated breakdown tended to have concurrent issues such as poor self care, increased age, increased time of spinal cord injury, poor nutrition, or other medical problems.
  
  
  CONCLUSIONS
  Chronic nonhealing pressure ulcers and myocutaneous flaps can be difficult to treat and evaluate with conventional methods. There are multiple reasons for failure to heal. MRI can be a useful tool for identifying some of these factors including osteomyelitis, fluid collections, abcesses, and sinus tracts in the perioperative period. Identifying the appropriate patient populations and clinical indications for the optimal use of MRI should be subject of further study.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Ruan
authors.forename: E
authors.initials: E
authors.lastname: Escobedo
authors.forename: S
authors.initials: S
authors.lastname: Harrison
authors.forename: B
authors.initials: B
authors.lastname: Goldstein
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D013524:Surgical Flaps / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*