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      Role of Plastic Surgeon in the Management of Pressure Ulcers during Rehabilitation of Patients with Traumatic Spinal Cord Injury: A Tertiary Hospital Experience

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          ABSTRACT

          Background

          Pressure ulcers and their management represent one of the most challenging situations following traumatic spinal cord injury (SCI). It requires frequent hospitalizations and hence aggravates the physical, psychological and socioeconomic burden of patients and their caregivers. Early surgical intervention will help in reducing the morbidity as well as improve the quality of life of these patients. In this study, we present a retrospective review of reconstructive surgeries for pressure sores highlighting the role of the plastic surgeon in the rehabilitation of traumatic SCI.

          Methods

          A three-year retrospective review (January 2014– December 2017) of 25 traumatic SCI patients who underwent reconstructive surgeries for pressure ulcers in the Department of Plastic Surgery in a Tertiary Care Government Hospital in South India was done. Variables like demographic and clinical details, reconstructive procedures done, postoperative complications, duration of hospital stay and relation of wound complication with serum albumin were statistically analyzed and interpreted using statistical package for social sciences (SPSS) software.

          Results

          Twenty-five male patients with age between 22 and 69 years (mean age = 49.4+/-12.24)were analyzed. 88% of the patients (n = 22) had paraplegia, and 12% had quadriplegia. 12% of patients had a cervical spinal injury, while 88% had a thoracolumbar injury. Mean duration of hospital stay was 36.5 days. Of the 25 patients, 68% (n = 17) had pressure sores at multiple sites while the rest had a single pressure sore. Of the total 49 pressure sores, 30 were ischial, 11 sacral, 7 trochanteric and one perineal pressure sore. Forty-five pressure sores were of grade II/IV and was managed with various flap reconstructions. One sacral pressure sore and one ischial pressure sore (grade II) underwent excision and primary closure. Split skin grafting was done for 2 sacral pressure sores. Postoperative wound complications were analyzed and there was a significant relation between hypoalbuminemia and major wound complications (Fischer exact p = <0.0001)

          Conclusion

          Plastic surgeons have an important role to play in the rehabilitation phase of traumatic spinal cord injury patients with pressure sores. Early reconstructive surgeries for pressure sores will prevent the development of complications and provide better quality of life (QOL) for these patients.

          Abbreviations

          SCI–Traumatic spinal cord injury

          QOL–Quality of life

          How to cite this article

          Bhooshan LS, Binod P, Lekshmi M. Role of Plastic Surgeon in the Management of Pressure Ulcers during Rehabilitation of Patients with Traumatic Spinal Cord Injury: A Tertiary Hospital Experience. J Spinal Surg 2018;5(4):162-169.

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          Most cited references10

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          Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends.

          Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem.
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            Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years.

            To identify predictors of pressure ulcers in men with spinal cord injury over a 3-year period.
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              The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper.

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                Author and article information

                Contributors
                Role: Assistant Professor
                Role: Associate Professor
                Role: Professor and Head
                Journal
                JOSS
                The Journal of Spinal Surgery
                JOSS
                Jaypee Brothers Medical Publishers
                2349-0462
                2348-6031
                October-December 2018
                : 5
                : 4
                : 162-169
                Affiliations
                [1-3 ] Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
                Author notes
                Lekshmi S Bhooshan, Assistant Professor, Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India Phone: +919744015102, e-mail: lekshmibhooshan@ 123456gmail.com
                Article
                10.5005/jp-journals-10039-1192
                48a63756-dd68-4923-9380-997a4da02fd2
                Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.

                Creative Commons Attribution 4.0

                History
                Categories
                ORIGINAL ARTICLE
                Custom metadata
                joss-2018-5-162.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Trochanteric sores,Sacral sores,Ischial,Rehabilitation,Plastic surgeon,Traumatic spinal cord injury,Pressure ulcers,Reconstructive surgery,Management

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