title: Elective stoma construction improves outcomes in medically intractable pressure ulcers.
abstract: OBJECTIVE
  Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not.
  
  
  METHODS
  A retrospective review was performed on all disabled patients who underwent surgery for medically intractable pressure ulcer from 1993 to 2001. Charts were divided into the colostomy group or noncolostomy group. Recurrence rates, healing times, morbidity and mortality, and number of reoperations were calculated for each group. Additionally, stoma patients were interviewed for quality of life assessment.
  
  
  RESULTS
  Sixty-seven patients were treated during the study period (colostomy, n = 41; noncolostomy, n = 26). The majority of colostomies were performed laparoscopically, with a 9.7 percent incidence of postoperative complications. The ulcer recurrence rate was lower in the treated colostomy group (43 percent) compared with the noncolostomy group (69 percent; P < 0.05). In addition, noncolostomy patients had longer healing times (7 vs. 3 months; P < 0.05), and this group required more ulcer operations than the stoma patients did. Quality of life and bowel care were much improved by the colostomy.
  
  
  CONCLUSIONS
  Stoma construction is a safe procedure with low morbidity and mortality that helps heal pressure ulcers and decreases the incidence of recurrence. Additionally, laparoscopic stoma construction represents a technical advance that may reduce operative complications that have been previously reported with open fecal diversion.
authors: Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Sebastian G
authors: SG
authors: de la Fuente
authors: L Scott
authors: LS
authors: Levin
authors: James D
authors: JD
authors: Reynolds
authors: Carmen
authors: C
authors: Olivares
authors: Theodore N
authors: TN
authors: Pappas
authors: Kirk A
authors: KA
authors: Ludwig
authors: Christopher R
authors: CR
authors: Mantyh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D003668:Pressure Ulcer / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology