Surgical management of pressure ulcers during inpatient neurologic rehabilitation: outcomes for patients with spinal cord disease.
OBJECTIVE
To study efficacy of surgery in the management of pressure ulcers and evaluate the effect of simultaneous comprehensive rehabilitation in improving outcome.


METHODS
Prospective, follow-up study.


METHODS
Neurologic rehabilitation unit of a tertiary care center.


METHODS
Patients with spinal cord diseases who had stage III/IV pressure ulcers underwent surgical reconstruction and inpatient rehabilitation in 2005 with a minimum follow-up duration of 1 year.


METHODS
Ulcer healing rate, postoperative complications, ulcers recurrence rate, and neurologic (ASIA grade), and functional recovery (Barthel Index).


METHODS
Frequency analysis and paired t test on SPSS 13.0.


RESULTS
Surgical intervention was carried out in 25 participants (19 men, 6 women), having a total of 39 ulcers (13 Stage III, 23 Stage IV, 3 unstaged). Surgeries performed were debridement (3), split skin grafting (13), and flap mobilization and closure (23). Only 4 participants (16.6%) had initial complications: wound dehiscence (2) and delayed graft healing (2). Follow-up rate was 92.0% (23/25 patients), with a duration of 12 to 21 months (mean, 15.4 +/- 7.45 months), and only 4 participants (17.3%) had ulcer recurrence. The majority of participants (13 of 25; 56.5%) improved neurologically on ASIA grade and functional evaluation on Barthel Index, suggesting statistically significant improvement (P < 0.005).


CONCLUSIONS
All outcome variables showed significant improvement at follow-up with good ulcer healing rate (87.0%), low initial complication (16.6%) and recurrence rates (17.3%), and good neurologic (56.5%) and functional (P < 0.005) recovery. Timely surgical interventions are necessary for Stage III to IV pressure ulcers, and simultaneous inpatient rehabilitation significantly improves outcome of patients with spinal cord disease.
Srivastava
Abhishek
A
Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. abhisrivastav_jai@yahoo.com
Gupta
Anupam
A
Taly
Arun B
AB
Murali
Thyloth
T
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008297:Male; D026741:Physical Therapy Modalities; D003668:Pressure Ulcer / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery*; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications; D016896:Treatment Outcome; D014945:Wound Healing