Wound digest


patients: A prospective multicenter randomized-controlled trial (ISRCTN17553857). Wound Rep Reg 2010;18: 572–579


5


Laing T, Ekpete N, Oon S, Carroll S. Surgical reconstruction of pressure sore defects: a single or two-stage procedure? J Wound Ostomy Continence Nurs 2010; 37(6): 615-8


Two-stage pressure ulcer reconstruction achieves good clinical outcomes


Readability Relevance to daily practice Novelty factor


n In this study the authors present their experience of the staged approach to pressure ulcer management, and review the evidence for staged versus single-procedure management involving debridement followed immediately by definitive reconstruction


n Retrospective analysis of the medical notes of all patients referred for pressure ulcer management to the National Rehabilitation Hospital, Ireland, from October 2001 to October 2007 was carried out


n All pressure ulcers managed surgically underwent initial debridement followed separately by surgical reconstruction in suitable candidates. Length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing were monitored for each patient


n A total of 108 patients (80% male) aged 36-79 years were referred for pressure ulcer management and, of these, 41 were managed surgically. The 41 patients had 58 pressure ulcers and all underwent debridement, with 20 patients then undergoing 23 surgical reconstruction procedures. Surgical procedures included primary closure in one individual and split thickness skin grafts in seven patients


n Post-surgical complications occurred in five individuals (20%). Partial flap necrosis occurred in three cases and skin graft failure in two cases, but there were no episodes of flap failure


n Mean time to complete wound healing was reported to be 17.4 weeks


n The authors reviewed 48 published studies of pressure ulcer reconstruction, of which two dealt with the single-stage approach. While flap failure rates were generally low, it was difficult to compare the two approaches because of methodological differences between the studies


n The authors conclude that, given the good clinical outcomes achieved by their own two-stage approach to pressure ulcer management and the paucity of data confirming any major advantage to single- step reconstruction, there is currently no support for them to change their approach to surgical management.


6


New tool for pressure ulcer risk assessment shows promise


Readability Relevance to daily practice Novelty factor


n The aim of this prospective, two-phase study was to describe pressure ulcers occurring in a surgical intensive care unit and to report on preliminary work to develop a new pressure ulcer risk assessment tool which takes into account co-morbidities and other factors not usually incorporated by other instruments


n N=369 patients (56.4% male, 43.6% female, mean age 58.3+ 19.3 years) managed in the surgical intensive care unit at Yale-New Haven Hospital, Connecticut, were included in the study


n A literature search was conducted to determine possible co-morbidities associated with pressure ulcer development in critical care patients, and this was then used to develop the first draft of the SICU Pressure Ulcer Risk Assessment (SPURA) scale


n Demographic and clinical data were collected for each patient, and skin assessment carried out. Data were collected between March 2005 and May 2008


n Patient data from an initial 230 individuals was used to modify the SPURA instrument, with three clinical experts used to validate content


n The modified instrument was then used to examine data from a further 139 patients


n 88 (23.9%) of patients admitted to the surgical ICU developed a hospital-acquired pressure ulcer. Braden Scale scores ranged from 6 to 21, with a mean score of 11.9 + 2.2


n Independent predictors of pressure ulcer development were lower Braden Scale score, diabetes mellitus, and patient age 70 years or older. The authors have incorporated these factors into the preliminary SPURA scale and conclude that patients with these factors may benefit from more aggressive pressure ulcer preventative care


n The SPURA scale is being further developed to assess PU risk in the critical care population; the authors stress that further psychometric testing will be needed before it can be recommended for use in research or clinical practice.


Slowikowski GC, Funk M. Factors associated with pressure ulcers in patients in a surgical intensive care unit. J Wound Ostomy Continence Nurs 2010; 37(6): 619–26.


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