THE ROLE OF FREE TISSUE TRANSFER IN THE RECONSTRUCTION OF PRESSURE ULCERS AND REDUCTION OF RECURRENCE RATE
Location
Medical Education Building, LSUHSC-NO
Presentation Date
10-10-2019 10:00 AM
End Date
10-10-2019 12:00 PM
Description
Background: Pressure ulcers (PU) are common, particularly in paraplegic patients. Stage III/IV PU that are refractory to nonsurgical interventions often require local flap reconstruction. Unfortunately, PU recurrences are common, with reported incidences of 33-82% at 1-year following reconstruction. Objective: Multiple reports of free tissue transfer for PU reconstruction exist but to our knowledge no systematic review has been performed. Here, we report the results of a systematic literature review and offer guidelines for the use of free tissue transfer for PU reconstruction. Additionally, we provide an analysis of the free flap and pressure ulcer reconstruction cost literature to determine if free flaps would significantly increase the cost of PU reconstruction. Methods: A systematic review of available English-language, peer-reviewed literature was conducted using the following electronic databases over the period 1900-2019 to identify pertinent publications: PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. The literature search was conducted using the following combination of terms: “free flap” AND “pressure ulcer”. The articles were individually screened for relevance based on their titles, abstracts, and full texts. Results: Our systemic review found 30 cases of free flap reconstruction for ischial pressure ulcers. Successful coverage of ischial pressure ulcers and overall reduction in recurrence was reported at 30 months mean follow up. Overall, 94% of the flaps healed well with no recurrence. Only two cases of recurrence were reported. The average recurrence rate following free flap reconstruction for pressure ulcers was 5%, compared to the 38% average recurrence rate following pressure ulcer reconstruction with fasciocutaneous and myocutaneous flaps. Conclusion: Compared to local flaps, free tissue transfer for PU reconstruction yielded increased success rates, reduced recurrence rates, and less complications. Free tissue transfer costs more initially due to longer operation times, but prove to be more cost-effective due to reduced post-operative complications and long-term wound closure. We recommend considering free flaps when conservative measures, local flap reconstruction, and alternative therapies result in a recurrent PU.
Recommended Citation
Robertson, Chelsi BS and Patterson, Charles MD, "THE ROLE OF FREE TISSUE TRANSFER IN THE RECONSTRUCTION OF PRESSURE
ULCERS AND REDUCTION OF RECURRENCE RATE" (2019). Medical Student Research Poster Symposium. 36.
https://digitalscholar.lsuhsc.edu/sommrd/2019/posters/36
THE ROLE OF FREE TISSUE TRANSFER IN THE RECONSTRUCTION OF PRESSURE ULCERS AND REDUCTION OF RECURRENCE RATE
Medical Education Building, LSUHSC-NO
Background: Pressure ulcers (PU) are common, particularly in paraplegic patients. Stage III/IV PU that are refractory to nonsurgical interventions often require local flap reconstruction. Unfortunately, PU recurrences are common, with reported incidences of 33-82% at 1-year following reconstruction. Objective: Multiple reports of free tissue transfer for PU reconstruction exist but to our knowledge no systematic review has been performed. Here, we report the results of a systematic literature review and offer guidelines for the use of free tissue transfer for PU reconstruction. Additionally, we provide an analysis of the free flap and pressure ulcer reconstruction cost literature to determine if free flaps would significantly increase the cost of PU reconstruction. Methods: A systematic review of available English-language, peer-reviewed literature was conducted using the following electronic databases over the period 1900-2019 to identify pertinent publications: PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. The literature search was conducted using the following combination of terms: “free flap” AND “pressure ulcer”. The articles were individually screened for relevance based on their titles, abstracts, and full texts. Results: Our systemic review found 30 cases of free flap reconstruction for ischial pressure ulcers. Successful coverage of ischial pressure ulcers and overall reduction in recurrence was reported at 30 months mean follow up. Overall, 94% of the flaps healed well with no recurrence. Only two cases of recurrence were reported. The average recurrence rate following free flap reconstruction for pressure ulcers was 5%, compared to the 38% average recurrence rate following pressure ulcer reconstruction with fasciocutaneous and myocutaneous flaps. Conclusion: Compared to local flaps, free tissue transfer for PU reconstruction yielded increased success rates, reduced recurrence rates, and less complications. Free tissue transfer costs more initially due to longer operation times, but prove to be more cost-effective due to reduced post-operative complications and long-term wound closure. We recommend considering free flaps when conservative measures, local flap reconstruction, and alternative therapies result in a recurrent PU.
Comments
Mentor: Frank Lau, MD