Skip to main content
Top
Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research Article

Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients

Authors: Jing-Chun Zhao, Bo-Ru Zhang, Kai Shi, Jia-Ao Yu, Jian Wang, Qing-Hua Yu, Lei Hong

Published in: BMC Geriatrics | Issue 1/2017

Login to get access

Abstract

Background

Surgical repair of severe pressure ulcers (PUs) in elderly patients remains a challenge for clinicians due to the complicated comorbidities and the special physical characteristics of elderly patients. The objective of this study was to evaluate the application of couple-kissing flaps (CKF) in the reconstruction of sacral PUs in these patients.

Methods

Elderly patients (over 70 years) with stage 3 or stage 4 PUs who underwent CKF immediately after radical debridement between July 2012 and December 2015 were enrolled in this retrospective study. Patients’ demographics were extracted from the medical records.

Results

A total of 12 patients were involved in this study. The average age of the patients was 76.83 years (ranged from 71 to 92 years). The donor site was closed primarily in all cases. All the flaps healed uneventfully without complications. Follow-up observations were conducted for an average of 13.6 months (ranged from 9 months to 2 years). Cosmetic results were satisfactory, with no surgical site breakdown or recurrence of PU in any of the cases. Three representative cases are presented.

Conclusions

The CKF is a reliable and satisfactory option for the reconstruction of severe sacral PUs defects in elderly patients. CKF is associated with an relatively low rate of complications and recurrence.
Literature
2.
go back to reference Thomas DR. Role of nutrition in the treatment and prevention of pressure ulcers. Nutr Clin Pract. 2014;29:466–72.CrossRefPubMed Thomas DR. Role of nutrition in the treatment and prevention of pressure ulcers. Nutr Clin Pract. 2014;29:466–72.CrossRefPubMed
3.
go back to reference Sardo PM, Simões CS, Alvarelhão JJ, Simões JF, Machado PA, Amado FM, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. J Tissue Viability. 2016;25:209–15.CrossRefPubMed Sardo PM, Simões CS, Alvarelhão JJ, Simões JF, Machado PA, Amado FM, et al. Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital. J Tissue Viability. 2016;25:209–15.CrossRefPubMed
4.
go back to reference Severens JL, Habraken JM, Duivenvoorden S, Frederiks CM. The cost of illness of pressure ulcers in The Netherlands. Adv Skin Wound Care. 2002;15:72–7.CrossRefPubMed Severens JL, Habraken JM, Duivenvoorden S, Frederiks CM. The cost of illness of pressure ulcers in The Netherlands. Adv Skin Wound Care. 2002;15:72–7.CrossRefPubMed
5.
go back to reference Schoonhoven L, Bousema MT, Buskens E, prePURSE-study group. The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study. Int J Nurs Stud. 2007;44:927–35.CrossRefPubMed Schoonhoven L, Bousema MT, Buskens E, prePURSE-study group. The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study. Int J Nurs Stud. 2007;44:927–35.CrossRefPubMed
6.
go back to reference Dugaret E, Videau MN, Faure I, Gabinski C, Bourdel-Marchasson I, Salles N. Prevalence and incidence rates of pressure ulcers in an emergency department. Int Wound J. 2014;11:386–91.CrossRefPubMed Dugaret E, Videau MN, Faure I, Gabinski C, Bourdel-Marchasson I, Salles N. Prevalence and incidence rates of pressure ulcers in an emergency department. Int Wound J. 2014;11:386–91.CrossRefPubMed
7.
go back to reference Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013;22:2183–91.CrossRefPubMed Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013;22:2183–91.CrossRefPubMed
8.
go back to reference VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008-2009 international pressure ulcer prevalence survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55:39–45.PubMed VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008-2009 international pressure ulcer prevalence survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55:39–45.PubMed
9.
go back to reference Sae-Sia W, Wipke-Tevis DD, Williams DA. Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res. 2005;18:29–35.CrossRefPubMed Sae-Sia W, Wipke-Tevis DD, Williams DA. Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res. 2005;18:29–35.CrossRefPubMed
10.
go back to reference Borghardt AT, Prado TN, Bicudo SD, Castro DS, Bringuente ME. Pressure ulcers in critically ill patients: incidence and associated factors. Rev Bras Enferm. 2016;69:460–7.CrossRefPubMed Borghardt AT, Prado TN, Bicudo SD, Castro DS, Bringuente ME. Pressure ulcers in critically ill patients: incidence and associated factors. Rev Bras Enferm. 2016;69:460–7.CrossRefPubMed
11.
go back to reference Bliss DZ, Gurvich O, Savik K, Eberly LE, Harms S, Mueller C, et al. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Arch Gerontol Geriatr. 2017;72:187–94.CrossRefPubMed Bliss DZ, Gurvich O, Savik K, Eberly LE, Harms S, Mueller C, et al. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Arch Gerontol Geriatr. 2017;72:187–94.CrossRefPubMed
12.
go back to reference Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J, et al. The cost of prevention and treatment of pressure ulcers: a systematic review. Int J Nurs Stud. 2015;52:1754–74.CrossRefPubMed Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J, et al. The cost of prevention and treatment of pressure ulcers: a systematic review. Int J Nurs Stud. 2015;52:1754–74.CrossRefPubMed
13.
go back to reference Dwivedi MK, Srivastava RN, Bhagat AK, Agarwal R, Baghel K, Jain A, et al. Pressure ulcer management in paraplegic patients with a novel negative pressure device: a randomised controlled trial. J Wound Care. 2016;25:199–200. 202-4, 206-7 CrossRefPubMed Dwivedi MK, Srivastava RN, Bhagat AK, Agarwal R, Baghel K, Jain A, et al. Pressure ulcer management in paraplegic patients with a novel negative pressure device: a randomised controlled trial. J Wound Care. 2016;25:199–200. 202-4, 206-7 CrossRefPubMed
14.
go back to reference AbouIssa A, Mari W, Simman R. Clinical usage of an extracellular, collagen-rich matrix: a case series. Wounds. 2015;27:313–8.PubMed AbouIssa A, Mari W, Simman R. Clinical usage of an extracellular, collagen-rich matrix: a case series. Wounds. 2015;27:313–8.PubMed
15.
go back to reference Neyens JCL, Cereda E, Meijer EP, Lindholm C, Schols JMGA. Arginine-enriched oral nutritional supplementation in the treatment of pressure ulcers: a literature review. Wound Med. 2017;16:46–51.CrossRef Neyens JCL, Cereda E, Meijer EP, Lindholm C, Schols JMGA. Arginine-enriched oral nutritional supplementation in the treatment of pressure ulcers: a literature review. Wound Med. 2017;16:46–51.CrossRef
16.
go back to reference Haiun M, Feuvrier D, Bayti T, Pluvy I, Pauchot J. Surgical management of a series of pressureulcers: report of 61 cases. Ann Chir Plast Esthet. 2016;61:836–44.CrossRefPubMed Haiun M, Feuvrier D, Bayti T, Pluvy I, Pauchot J. Surgical management of a series of pressureulcers: report of 61 cases. Ann Chir Plast Esthet. 2016;61:836–44.CrossRefPubMed
17.
go back to reference Lin CT, Ou KW, Chiao HY, Wang CY, Chou CY, Chen SG, et al. Inferior gluteal artery perforator flap for sacral pressure ulcer reconstruction: a retrospective case study of 11 patients. Ostomy Wound Manage. 2016;62:34–9.PubMed Lin CT, Ou KW, Chiao HY, Wang CY, Chou CY, Chen SG, et al. Inferior gluteal artery perforator flap for sacral pressure ulcer reconstruction: a retrospective case study of 11 patients. Ostomy Wound Manage. 2016;62:34–9.PubMed
18.
go back to reference Livesley NJ, Chow AW. Infected pressure ulcers in elderly individuals. Clin Infect Dis. 2002;35:1390–6.CrossRefPubMed Livesley NJ, Chow AW. Infected pressure ulcers in elderly individuals. Clin Infect Dis. 2002;35:1390–6.CrossRefPubMed
19.
go back to reference Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52:359–67.CrossRefPubMed Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52:359–67.CrossRefPubMed
20.
go back to reference Jaul E. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly. Chron Wound Care Manage Res. 2014;1:3–9.CrossRef Jaul E. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly. Chron Wound Care Manage Res. 2014;1:3–9.CrossRef
21.
go back to reference Batra RK, Aseeja V. VAC therapy in large infected sacral pressure ulcer gradeIV –can be an alternative to flap reconstruction? Indian J Surg. 2014;76:162–4.CrossRefPubMed Batra RK, Aseeja V. VAC therapy in large infected sacral pressure ulcer gradeIV –can be an alternative to flap reconstruction? Indian J Surg. 2014;76:162–4.CrossRefPubMed
22.
go back to reference Mouës CM, van den Bemd GJ, Heule F, Hovius SE. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial. J Plast Reconstr Aesthet Surg. 2007;60:672–81.CrossRefPubMed Mouës CM, van den Bemd GJ, Heule F, Hovius SE. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial. J Plast Reconstr Aesthet Surg. 2007;60:672–81.CrossRefPubMed
23.
go back to reference Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31:631–6.CrossRefPubMed Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31:631–6.CrossRefPubMed
24.
go back to reference Han HH, Choi EJ, Moon SH, Lee YJ, Oh DY. Combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps for treating sacral sores. Biomed Res Int. 2016;2016:8714713.PubMedPubMedCentral Han HH, Choi EJ, Moon SH, Lee YJ, Oh DY. Combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps for treating sacral sores. Biomed Res Int. 2016;2016:8714713.PubMedPubMedCentral
25.
go back to reference Wong TC, Ip FK. Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores. Int Orthop. 2006;30:64–7.CrossRefPubMed Wong TC, Ip FK. Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores. Int Orthop. 2006;30:64–7.CrossRefPubMed
27.
go back to reference Maslauskas K, Samsanavicius D, Rimdeika R, Kaikaris V. Surgical treatment of pressure ulcers: an 11-year experience at the Department of Plastic and Reconstructive Surgery of Hospital of Kaunas University of medicine. Medicina (Kaunas). 2009;45:269–75. Maslauskas K, Samsanavicius D, Rimdeika R, Kaikaris V. Surgical treatment of pressure ulcers: an 11-year experience at the Department of Plastic and Reconstructive Surgery of Hospital of Kaunas University of medicine. Medicina (Kaunas). 2009;45:269–75.
28.
go back to reference Thiessen FE, Andrades P, Blondeel PN, Hamdi M, Roche N, Stillaert F, et al. Flap surgery for pressure sores: should the underlying muscle be transferred or not? J Plast Reconstr Aesthet Surg. 2011;64:84–90.CrossRefPubMed Thiessen FE, Andrades P, Blondeel PN, Hamdi M, Roche N, Stillaert F, et al. Flap surgery for pressure sores: should the underlying muscle be transferred or not? J Plast Reconstr Aesthet Surg. 2011;64:84–90.CrossRefPubMed
29.
go back to reference Demiryilmaz I, Yilmaz I, Peker K, Celebi F, Cimen O, Isik A, et al. Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease. Med Sci Monit. 2014;20:1263–6.CrossRefPubMedPubMedCentral Demiryilmaz I, Yilmaz I, Peker K, Celebi F, Cimen O, Isik A, et al. Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease. Med Sci Monit. 2014;20:1263–6.CrossRefPubMedPubMedCentral
30.
go back to reference Hsiao YC, Chuang SS. Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores. J Plast Surg Hand Surg. 2015;49:3–7.CrossRefPubMed Hsiao YC, Chuang SS. Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores. J Plast Surg Hand Surg. 2015;49:3–7.CrossRefPubMed
31.
go back to reference Prado A, Ocampo C, Danilla S, Valenzuela G, Reyes S, Guridi R. A new technique of “double-a” bilateralflapsbased on perforators for the treatment of sacral defects. Plast Reconstr Surg. 2007;119:1481–90.CrossRefPubMed Prado A, Ocampo C, Danilla S, Valenzuela G, Reyes S, Guridi R. A new technique of “double-a” bilateralflapsbased on perforators for the treatment of sacral defects. Plast Reconstr Surg. 2007;119:1481–90.CrossRefPubMed
32.
go back to reference Loesche M, Gardner SE, Kalan L, Horwinski J, Zheng Q, Hodkinson BP, et al. Temporal stability in chronic wound microbiota is associated with poor healing. J Invest Dermatol. 2017;137:237–44.CrossRefPubMed Loesche M, Gardner SE, Kalan L, Horwinski J, Zheng Q, Hodkinson BP, et al. Temporal stability in chronic wound microbiota is associated with poor healing. J Invest Dermatol. 2017;137:237–44.CrossRefPubMed
33.
go back to reference Gahukamble AD, Nithyananth M, Cherian VM, Shah AP. Postoperative tuberculous wound infection treated by reverse sural artery fasciocutaneous flap. J Plast Reconstr Aesthet Surg. 2009;62:e672–4.CrossRefPubMed Gahukamble AD, Nithyananth M, Cherian VM, Shah AP. Postoperative tuberculous wound infection treated by reverse sural artery fasciocutaneous flap. J Plast Reconstr Aesthet Surg. 2009;62:e672–4.CrossRefPubMed
34.
go back to reference Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J. A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg. 2012;130:67e–77e.CrossRefPubMed Sameem M, Au M, Wood T, Farrokhyar F, Mahoney J. A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores. Plast Reconstr Surg. 2012;130:67e–77e.CrossRefPubMed
Metadata
Title
Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients
Authors
Jing-Chun Zhao
Bo-Ru Zhang
Kai Shi
Jia-Ao Yu
Jian Wang
Qing-Hua Yu
Lei Hong
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0680-4

Other articles of this Issue 1/2017

BMC Geriatrics 1/2017 Go to the issue