title: Parallel pocket incision: Less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining.
abstract: BACKGROUND
  The treatment of deep pressure ulcer with a wide wound edge undermining (pocket) is challenging, especially when conservative treatments are ineffective. As most patients with a pressure ulcer suffer from systemic comorbidities, invasive surgery cannot be performed on all patients, and less invasive treatment is required.
  
  
  METHODS
  Less invasive surgical intervention to a deep pressure ulcer, parallel pocket incision (PPI), was performed on 10 patients with intractable pressure ulcers with a pocket formation. In PPI procedures, two parallel skin incisions were made to open up the deepest fold of the pocket and to preserve the skin overlying the pocket lesion; through the created incisions, the necrotic tissues around the deepest fold of the undermining could be easily removed, which facilitated spontaneous wound healing. Postoperative results and complications were evaluated.
  
  
  RESULTS
  All PPI procedures were safely performed under local infiltration anesthesia without major postoperative complication; minor bleeding was seen intraoperatively in three patients, which could be easily controlled with electric cautery coagulation. Nine of 10 ulcers were cured after PPI, and one could not be followed up due to the patient's death non-related to the pressure ulcer. For the nine cured patients, the average time for cure was 14.9 weeks, and no recurrence was observed at postoperative 6 months.
  
  
  CONCLUSIONS
  PPI is a simple, technically easy, and less invasive surgical intervention to an intractable pressure ulcer with a pocket, which can be safely performed under local infiltration anesthesia even on a patient with severe systemic comorbidities.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan; Department of Plastic Surgery, Noda Hospital, Chiba, Japan. Electronic address: tyamamoto-tky@umin.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Akitatsu
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D003668:Pressure Ulcer / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Decubitus; Flap; Incision; Minimally invasive; Pressure ulcer; Surgery