National Outcomes of Flap Coverage for Pressure Ulcers Using ACS-NSQIP
Bao Ngoc N. Tran MD, Austin D. Chen, Parisa Kamali MD, Dhruv Singhal MD, Bernard T. Lee, MD, MBA, MPH, FACS, Eugene Y. Fukudome, MD
Department of Surgery, Division of Plastic and Reconstructive Surgery Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Background: Complication rates after flap coverage for pressure ulcers have been high historically. These patients tend to have multiple risk factors associated with poor wound healing and higher complications. This study utilizes data from the National Surgical Quality Improvement Program (NSQIP) to examine the perioperative outcomes of flap coverage for pressure ulcers.
Methods: Data captured within the NSQIP database for patient undergoing flap coverage for pressure ulcers between 2005-2014 was identified. Demographic, perioperative information, and complications were reviewed. ANOVA and Pearson's chi-squared were used to assess differences of means and proportions between groups, respectively. A multivariate logistic regression was performed to identify independent risk factors for complications.
Results: There were 755 cases of flap coverage for pressure ulcers identified: 365 (48%) for sacral ulcers, 321 (43%) for ischial ulcers, and 69 (9%) for trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists Class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial SSI. There were no observed flap failures. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications.
Conclusion: Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is relatively safe and effective with overall acceptable postoperative complications. This type of treatment should be considered for properly selected patients.
Back to 2017 Posters
