Abhishek Srivastava1, Anupam Gupta, Arun B Taly, Thyloth Murali. 1. Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. abhisrivastav_jai@yahoo.com
Abstract
BACKGROUND/ OBJECTIVE: To study efficacy of surgery in the management of pressure ulcers and evaluate the effect of simultaneous comprehensive rehabilitation in improving outcome. METHOD: Prospective, follow-up study. SETTING: Neurologic rehabilitation unit of a tertiary care center. PARTICIPANTS: Patients with spinal cord diseases who had stage III/IV pressure ulcers underwent surgical reconstruction and inpatient rehabilitation in 2005 with a minimum follow-up duration of 1 year. OUTCOME MEASURES: Ulcer healing rate, postoperative complications, ulcers recurrence rate, and neurologic (ASIA grade), and functional recovery (Barthel Index). STATISTICAL ANALYSIS: Frequency analysis and paired t test on SPSS 13.0. RESULTS: Surgical intervention was carried out in 25 participants (19 men, 6 women), having a total of 39 ulcers (13 Stage III, 23 Stage IV, 3 unstaged). Surgeries performed were debridement (3), split skin grafting (13), and flap mobilization and closure (23). Only 4 participants (16.6%) had initial complications: wound dehiscence (2) and delayed graft healing (2). Follow-up rate was 92.0% (23/25 patients), with a duration of 12 to 21 months (mean, 15.4 +/- 7.45 months), and only 4 participants (17.3%) had ulcer recurrence. The majority of participants (13 of 25; 56.5%) improved neurologically on ASIA grade and functional evaluation on Barthel Index, suggesting statistically significant improvement (P < 0.005). CONCLUSIONS: All outcome variables showed significant improvement at follow-up with good ulcer healing rate (87.0%), low initial complication (16.6%) and recurrence rates (17.3%), and good neurologic (56.5%) and functional (P < 0.005) recovery. Timely surgical interventions are necessary for Stage III to IV pressure ulcers, and simultaneous inpatient rehabilitation significantly improves outcome of patients with spinal cord disease.
BACKGROUND/ OBJECTIVE: To study efficacy of surgery in the management of pressure ulcers and evaluate the effect of simultaneous comprehensive rehabilitation in improving outcome. METHOD: Prospective, follow-up study. SETTING: Neurologic rehabilitation unit of a tertiary care center. PARTICIPANTS: Patients with spinal cord diseases who had stage III/IV pressure ulcers underwent surgical reconstruction and inpatient rehabilitation in 2005 with a minimum follow-up duration of 1 year. OUTCOME MEASURES: Ulcer healing rate, postoperative complications, ulcers recurrence rate, and neurologic (ASIA grade), and functional recovery (Barthel Index). STATISTICAL ANALYSIS: Frequency analysis and paired t test on SPSS 13.0. RESULTS: Surgical intervention was carried out in 25 participants (19 men, 6 women), having a total of 39 ulcers (13 Stage III, 23 Stage IV, 3 unstaged). Surgeries performed were debridement (3), split skin grafting (13), and flap mobilization and closure (23). Only 4 participants (16.6%) had initial complications: wound dehiscence (2) and delayed graft healing (2). Follow-up rate was 92.0% (23/25 patients), with a duration of 12 to 21 months (mean, 15.4 +/- 7.45 months), and only 4 participants (17.3%) had ulcer recurrence. The majority of participants (13 of 25; 56.5%) improved neurologically on ASIA grade and functional evaluation on Barthel Index, suggesting statistically significant improvement (P < 0.005). CONCLUSIONS: All outcome variables showed significant improvement at follow-up with good ulcer healing rate (87.0%), low initial complication (16.6%) and recurrence rates (17.3%), and good neurologic (56.5%) and functional (P < 0.005) recovery. Timely surgical interventions are necessary for Stage III to IV pressure ulcers, and simultaneous inpatient rehabilitation significantly improves outcome of patients with spinal cord disease.
Authors: J González Sarasúa; S Pérez López; M Alvarez Viejo; M Pérez Basterrechea; A Fernández Rodríguez; A Ferrero Gutiérrez; J García Gala; Y Menéndez Menéndez; D Escudero Augusto; A Pérez Arias; J Otero Hernández Journal: J Spinal Cord Med Date: 2011 Impact factor: 1.985
Authors: János Jósvay; András Klauber; Béla Both; Péter B Kelemen; Zsombor Z Varga; Pál Cs Pesthy Journal: J Spinal Cord Med Date: 2014-10-09 Impact factor: 1.985