PMID- 29386657
OWN - NLM
STAT- MEDLINE
DCOM- 20180925
LR  - 20190704
IS  - 1476-5624 (Electronic)
IS  - 1362-4393 (Linking)
VI  - 56
IP  - 6
DP  - 2018 Jun
TI  - Outcome analyses of a multimodal treatment approach for deep pressure ulcers in 
      spinal cord injuries: a retrospective cohort study.
PG  - 582-590
LID - 10.1038/s41393-018-0065-3 [doi]
AB  - STUDY DESIGN: Retrospective observational cohort study. OBJECTIVES: To describe 
      outcomes, risk factors for complications, and relapse rates associated with the 
      multimodal treatment approach for deep pressure ulcers (PUs) grade IV for the 
      ischium, trochanter major, and sacral regions of patients with traumatic and 
      non-traumatic spinal cord injury (SCI). SETTING: The settings comprised two 
      spinal cord units within a maximum care hospital. The treatment of all patients 
      followed the modified interdisciplinary "Basler treatment concept". METHODS: We 
      included all individuals with SCI with a first occurrence of PU grade IV in the 
      buttocks area between August 2008 and December 2012 inclusive, with a maximum 
      follow-up of 3 years. Descriptive, univariate, and bivariate analyses were 
      undertaken, as were group comparisons. RESULTS: In 47 patients aged 18-87 years 
      (mean age: 51 years) a total of 63 fasciocutaneous and myocutaneous flaps were 
      performed. Wound healing was complete after a mean of 34 days (SD = 21). 
      Postoperative mobilisation in a wheelchair was performed after a mean of 46 days 
      (SD = 24). Delayed healing was reported in 18 patients (38%), and revision 
      surgery was necessary in five patients (11%). ASIA impairment scale (AIS) A 
      (p = .001), and male gender (p = .001) were identified as risk factors for 
      delayed wound healing and prolonged inpatient stay. Treatment-associated 
      pneumonia occurred in four cases (11% of all patients, 25% of patients with 
      tetraplegia). Patients were discharged when the time spent sitting in a 
      wheelchair was 2 x 2 h per day; this occurred after a mean of 100 days (SD = 36). 
      PU recurrence was observed in six cases (18%). CONCLUSIONS: Our multimodal 
      treatment concept was found to have complication rates comparable to those in the 
      literature; additionally, this approach might be associated with lower recurrence 
      rates with respect to the literature. To reduce high rates of pneumonia 
      occurrence among patients with tetraplegia, preventive measures need to be 
      established. Further evidence of the efficiency of this complex treatment 
      approach for PU in individuals with SCI is needed.
FAU - Kreutztrager, Martin
AU  - Kreutztrager M
AD  - Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, 
      Germany. Martin.kreutztraeger@ukb.de.
FAU - Voss, Heiko
AU  - Voss H
AD  - SRH Klinikum Karlsbad-Langensteinbach, Handchirurgie und Plastische Chirurgie, 
      Karlsbad, Germany.
FAU - Scheel-Sailer, Anke
AU  - Scheel-Sailer A
AUID- ORCID: 0000-0003-3820-6664
AD  - Swiss Paraplegic Centre (SPC), Nottwil, Switzerland.
FAU - Liebscher, Thomas
AU  - Liebscher T
AUID- ORCID: 0000-0002-6025-6564
AD  - Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, 
      Germany.
AD  - SRH Klinikum Karlsbad-Langensteinbach, Handchirurgie und Plastische Chirurgie, 
      Karlsbad, Germany.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20180131
PL  - England
TA  - Spinal Cord
JT  - Spinal cord
JID - 9609749
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Combined Modality Therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pressure Ulcer/epidemiology/*etiology/physiopathology/*therapy
MH  - Quadriplegia/epidemiology/etiology/physiopathology/therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Spinal Cord Injuries/*complications/epidemiology/physiopathology/*therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Wheelchairs
MH  - Wound Healing
MH  - Young Adult
EDAT- 2018/02/02 06:00
MHDA- 2018/09/27 06:00
CRDT- 2018/02/02 06:00
PHST- 2017/03/12 00:00 [received]
PHST- 2018/01/06 00:00 [accepted]
PHST- 2018/01/04 00:00 [revised]
PHST- 2018/02/02 06:00 [pubmed]
PHST- 2018/09/27 06:00 [medline]
PHST- 2018/02/02 06:00 [entrez]
AID - 10.1038/s41393-018-0065-3 [pii]
AID - 10.1038/s41393-018-0065-3 [doi]
PST - ppublish
SO  - Spinal Cord. 2018 Jun;56(6):582-590. doi: 10.1038/s41393-018-0065-3. Epub 2018 
      Jan 31.