title: Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis.
abstract: BACKGROUND
  Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage.
  
  
  METHODS
  This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection.
  
  
  RESULTS
  All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34).
  
  
  CONCLUSIONS
  Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Bamba
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: James J
authors.initials: JJ
authors.lastname: Madden
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Hoffman
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Justine S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Lillian B
authors.initials: LB
authors.lastname: Nanney
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Surgery, Georgetown University, Washington, D.C.; and ‡Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Spear