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Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 162-169

Role of plastic surgeon in the management of pressure ulcers during rehabilitation of patients with traumatic spinal cord injury: A tertiary hospital experience

1 Assistant Professor, Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
2 Associate Professor, Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
3 Professor and Head, Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India

Correspondence Address:
Lekshmi S Bhooshan
Assistant Professor, Department of Plastic Surgery, Government Medical College, Kottayam, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.5005/jp-journals-10039-1192

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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.

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