Table 27Surgery: Comparative effectiveness of intervention series

Author Year
Study Type
Quality
N Patients/nPU
Setting
Pressure Ulcer StageaMean Age (Range)
Sex
Population
FollowupSurgical InterventionOutcomes Measureda and Treatment Effecta
Foster 1997170
Observational
Fair
N=87;/nPU=112
Hospital
Stage III–IV ischial49 years (16–90)
Female: 26%
General (90% spinal cord injury)
11 months (1 month to 9 years)Myocutaneous flap
Fasciocutaneous flap
Healed wound by 1-month post surgery: inferior gluteus maximus island flap 32/34 (94%) vs. inferior gluteal thigh flap 25/27 (93%) vs. V-Y hamstring 7/12 (58%) vs. tensor fascia latae 6/12 (50%)

Harms (n):
Complications in 37%:
Slight wound edge dehiscence (16); partial flap necrosis (10); wound infection (5); wound dehiscence requiring reoperation (5); aspiration pneumonia (1); intraoperative myocardial infarction (1); deep venous thrombosis (1)
Foster 1997169
Observational
Fair
N=201/nPU=280
Hospital
Stage III–IV pelvic and trochanteric50 years (16–90)
Female: 35%
General (90% spinal cord injury)
12 months (1 month to 9 years)Myocutaneous flap
Fasciocutaneous flap
Healed wound by 1-month post surgery) 248/280 (89%)
Ischial: 94/113 (83%)
Sacral: 86/94 (91%)
Trochanter 68/73 (93%)

Complications:
Iscial: 47/113 (42%)
Sacral: 19/94 (20%)
Trochanter: 11/73 (15%)
Kierney1998166
Observational
Fair
N=158/nPU=268
Hospital
Stage III–IV pelvic and trochanteric35 years (NR)
Female: 22%
General (84% spinal cord injury/spina bifida)
3.7 years (1 month to 15.5 years)Primary closure split-thickness skin graft
Cutaneous flap
Limberg flap
Fasciocutaneous flap
Myocutaneous flap
Other
Recurrence rates:
Overall patient: 25%
Overall pressure ulcer: 19%
Sacral: 12%
Ischial: 21%,
Trochanter: 22%
FLAPS:
Cutaneous 12/44 (27%)
Limberg 2/11 (18%)
Fasciocutaneous 8/54 (15%)
Myocutaneous 13/99 (13%)
Spinal cord injured/spina bifida: 20–24% vs. others: 5%

Harms: NR
Schryvers 2000168
Observational
Fair
N=168/nPU=598
Hospital
Stage III–IV (communicate with muscle, bone, or joint) pelvic and trochanteric41 years (16–91)
Female: 22%
Spinal cord injury
1976–1996 (length of time from surgery to recurrence ranged from 2 months to 3 years)Primary closure vs. fasciocutaneous vs. myocutaneous flap closureComplete healing, days from surgery:
primary closure: n=65, 67.3 days
cutaneous/fasciocutaneous: n=237, 59.1 days
myocutaneous: n=86, 82.2 days

Recurrence rates:
Ischial 84/249 (34%)
Sacral 24/82 (29%)
Trochanteric 16/90 (18%)

Complications: (suture line dehiscence) in 31% overall
Ischial: 30%
Sacral: 30%
Trochanteric: 35%
Primary closure: 25/75 (34%)
Cutaneous flap: 66/253 (26%)
Myocutaneous flap: 39/93 (42%)
Yamamoto 1997167
Observational
Fair
N=53/nPU=69
Hospital
NR
pelvic
50 years (17–75)
Female: 9%
Paraplegic
3 years 6 months (range 4 months to 5 years 4 months)Fasciocutaneous vs. myocutaneous flapRecurrence rates:
Ischial: 22/45 (48.9%)
fasciocutaneous 27.8% vs. myocutaneous 63%
Sacral: 5/24 (20.8%)
fasciocutaneous 17.4% vs. myocutaneous 1/1 (100%)

Percent PUFS: at 36 months:
overall: sacral 70% vs. ischial 50% (p=0.28)

Ischial: fasciocutaneous 67.5% vs. myocutaneous 42.5%, p=0.055
No comparison of sacral sores by muscle flap group due to small sample size

Harms: NR

NPUAP = National Pressure Ulcer Advisory Panel; NR = not reported; PUFS = pressure ulcer free survival

a

Pressure ulcer stage indicates NPUAP staging unless otherwise noted. Non-NPUAP staging was converted to the equivalent NPUAP stage where possible.

From: Results

Cover of Pressure Ulcer Treatment Strategies: Comparative Effectiveness
Pressure Ulcer Treatment Strategies: Comparative Effectiveness [Internet].
Comparative Effectiveness Reviews, No. 90.
Saha S, Smith MEB, Totten A, et al.

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