Reconstructive Surgery of Pressure Injuries in Spinal Cord Injury/Disorder Patients: Retrospective Observational Study and Proposal of an Algorithm for the Flap Choice.

Pressure injuries (PIs) are a common complication in patients with spinal cord injury/disorder (SCI/D), and deep PIs require surgical treatment consisting of wide debridement and adequate reconstruction. We conducted a retrospective observational study at a tertiary rehabilitation hospital for SCI/D in Italy with the aim of describing the incidence and associated risk factors of postoperative complications in individuals with SCI/D presenting with chronic deep PIs, treated with a specific flap selection algorithm based on the site of the defect, the presence of scars from previous surgeries, and the need to spare reconstructive options for possible future recurrences. Medical records of surgical procedures performed on SCI/D patients with fourth-degree PIs, according to NPUAP classification (National Pressure Ulcer Advisory Panel), between July 2011 and January 2018 were reviewed. A total of 434 surgical procedures for fourth-degree PIs in 375 SCI/D patients were analyzed. After a mean follow-up of 21 months (range 12–36), 59 PIs (13.6%) had minor complications, and 17 (3.9%) had major complications requiring reoperation. The sacral site and muscular and musculocutaneous flaps were significant risk factors for postoperative complications. Six patients (1.4%) had a recurrence. The choice of flap correlates with the outcome of decubitus reconstruction. Therefore, reconstructive planning should be based on established principles

Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study

tudy design: Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol. Setting: Tertiary Rehabilitation Hospital for SCI/D in Italy. Methods: Retrospective analysis of the medical records of adult individuals with SCI/D, who developed a PI after the first discharge from a Spinal Unit, underwent flap surgery for PI between July 2011 and January 2018. The statistical unit of analysis was the surgical intervention. Logistic regression analysis with robust standard errors was performed to assess risk factors of post-surgical complications. Results: 434 surgical intervention records were included, for a total of 378 patients. The treated PIs were ischiatic in 56.2% of the cases, sacral in 32.5%, trochanteric in 15.7%, and 5.8% were in other sites. In 239 cases (55.1%) a histological diagnosis of osteomyelitis was confirmed. Minor complications occurred in 13.6% of interventions, while major complications were 3.9%. Sacral PI (OR = 2.55, 95%CI: 1.50–4.35) and muscular/musculocutaneous flap (OR = 2.12, 95%CI: 1.05–4.28) were significant factors associated with risk of post-surgical complications. After a mean follow-up of 21 months (range 12–36), six people (1.4%) had a recurrence. Patients with a recurrence had at least one comorbidity compared to 57% of people without recurrences (p = 0.036). Conclusion: Our results demonstrate that complication and recurrence rates can be minimized when an established interdisciplinary and rehabilitation protocol is integrated in the clinical management

Osteomyelitis of the pelvic bones in patients with spinal cord injury: Is magnetic resonance useful for preoperative diagnosis?

Aim of the study: We report a prospective, observational, single-centre study on adult patients with spinal cord injury (SCI) and pressure sores undergoing surgical debridement and reconstruction at Montecatone Rehabilitation Institute from July 2013 to January 2016. The aim is to assess usefulness of magnetic resonance (MR) in pre-operative diagnosis of osteomyelitis. Materials and methods: All the patients underwent preoperative MRI each MRI was evaluated independently by two radiologists and the exam was considered positive for osteomyelitis only when the two radiologists agreed on the diagnosis. All the surgical procedures consisted of a wide debridement of soft and bony tissues and reconstruction: bone specimens were collected and sent for culture and histopathological evaluation. Results of MRI and histopathology were compared. Results: 85 patients were included in the study. The two radiologists working independently agreed on the diagnosis of osteomyelitis in 96% of the cases. Pre-operative MRI was considered positive for osteomyelitis in 45 cases. According to histology, osteomyelitis was diagnosed in 40 patients. MRI findings and histology were concordant in 61% of cases; 19 false positive and 14 false negative cases were found. Sensitivity and specificity of MR in the diagnosis of osteomyelitis were 65% and 58% respectively, with a positive predictive value of 58% and a negative predictive value of 65%. Conclusion: In our cohort sensitivity, specificity, positive predictive value and negative predictive value of MR for the diagnosis of osteomyelitis in patients with SCI and pressure ulcers are lower than previously described. Our findings suggest that MRI cannot be considered a reliable diagnostic technique for the diagnosis of osteomyelitis. We can conclude that MRI is not indispensable pre-operatively in SCI patients with pressure sores, and that all the patient should undergo a wide soft and bony tissues debridement as if they were all affected by osteomyelitis. Histological diagnosis is useful to decide the timing of antimicrobial therapy, that should be planned based on the results of the surgical specimen culture. Further studies are needed to investigate this topic