Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach.
OBJECTIVE
Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced.


METHODS
A retrospective review of consecutive patients in the multidisciplinary pressure sore clinic was performed. Data were collected on patient demographics, reconstructive techniques, surgical outcomes and readmission for any complications.


RESULTS
In total, 45 patients with 60 pressure sores (grade 3 or 4) were reviewed in the joint clinic between 2005 and 2011. The majority of patients were paraplegic (78%), while the remaining 22% were tetraplegic. Ischial sores were the most common (45%) followed by trochanteric (23%) and sacral (20%) sores. Multiple sores were noted in 44% of patients. Flap reconstruction was required in 32 patients (71%); after a mean follow-up time of 33 months (range 25-72 months), there were three (9%) major complications (two recurrences of pressure sores and one sinus) and seven (22%) minor complications. After introduction of patient care pathways through the multidisciplinary approach, the rate of readmission for complications decreased from 14% to 5.5% and inpatient stay upon readmission reduced from 65 to 45 days.


CONCLUSIONS
Implementation of a multidisciplinary approach was key to optimising surgical outcomes, achieving a low recurrence rate (6%) and reducing readmissions.
Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK. Electronic address: stadiparthi@hotmail.com.
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Tadiparthi
Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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Hartley
Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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Alzweri
The Golden Jubilee North East Regional Spinal Injuries Centre, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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Mecci
Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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Siddiqui
D005260:Female; D005269:Femur / Q000473:pathology; D006801:Humans; D008161:Lumbosacral Region / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology; D010348:Patient Care Team / Q000458:organization & administration*; D003668:Pressure Ulcer / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis; D013524:Surgical Flaps; D006113:United Kingdom
Ischial sores; Paraplegia; Pressure sores; Sacral sores; Spinal injury; Trochanteric sores