Risk factors of pelvic pressure ulcer recurrence after primary skin flap surgery in people with spinal cord injury

• Published in: Annals of physical and rehabilitation medicine Vol. 62; no. 2; pp. 77 - 83
• Main Authors: Morel, J., Herlin, C., Amara, B., Mauri, C., Rouays, H., Verollet, C., Almeras, I., Frasson, N., Dupeyron, A., Jourdan, C., Daures, J.-P., Gelis, A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01-03-2019; Elsevier Masson
• Subjects: Adult; Aged; Aged, 80 and over; Female; Flap surgery; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Pelvis; Postoperative Complications - etiology; Postoperative Complications - pathology; Pressure ulcer; Pressure Ulcer - etiology; Pressure Ulcer - pathology; Proportional Hazards Models; Recurrence; Regression Analysis; Retrospective Studies; Risk factor; Risk Factors; Skin Transplantation - adverse effects; Spinal Cord Injuries - complications; Spinal Cord Injuries - surgery; Spinal cord injury; Surgical Flaps - adverse effects; Treatment Outcome; Young Adult; Recurrence; Flap surgery; Spinal cord injury; Pressure ulcer; Risk factor
• DOI: 10.1016/j.rehab.2018.08.005
• EISSN: 1877-0665
• ISSN: 1877-0657

•After pressure ulcer surgery, the risk of recurrence remains constant during the first 4 years postoperatively in people with spinal cord injury.•The risk of recurrence concerns the surgical site as well as the entire pelvic region.•Local postoperative complications are not related to the risk of recurrence.•Structured long-term follow-up and monitoring is needed after pressure ulcer surgery for people with spinal cord injury.
Flap surgery for deep pelvic pressure ulcers (PPUs) has been found effective, but the recurrence rate remains high and few risk factors have been identified.
We evaluated risk factors for PU recurrence after primary flap surgery in people with spinal cord injury (SCI).
This observational retrospective study based on medical charts included all individuals with SCI who underwent primary flap surgery for a PPU in the Hérault department in France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomic and care management factors were studied. The primary outcome was PPU recurrence (surgical site and/or other pelvic site). The secondary outcome was recurrence at the surgical site. Cox proportional hazards regression was used to determine associated factors, estimating hazard ratios (HRs) and 95% confidence intervals (CIs).
We included 85 patients. Half had a PPU recurrence, and in one-third, the recurrence was at the surgical site. On multivariate analysis, global PPU recurrence was associated with colostomy (HR=2.79) and living with a partner (HR=2.29). Non-traumatic SCI and sacral wound were associated with PPU recurrence (HR=3.39, HR=0.48) and recurrence at the surgical site (HR=3.3, HR=0.3).
Risk factors of PPU recurrence are based on both biomedical and social models. After primary flap surgery, the risk of recurrence justifies regular follow-up and strict monitoring.