Journal de la colonne vertébrale

Reduction of ‘Dead Space’ and ‘Shear’ Through Flap Adhesion may Reduce Short Term Complication Rates in Flap-Based Reconstruction for Stage IV Pressure Sores: A Retrospective Comparison Cohort Series

Abstract

Ingo Kuhfuss, Alessandro Cordi and Philip Zeplin

Early complications such as dehiscence, seroma and flap failure requiring revision are a troubling aspect of flap repair surgery for Stage IV pressure ulcers. They increase patient suffering in an already difficult context and place a great burden on the health care provider as well. Reduction or elimination of the dead space between tissue planes has been shown to aid in wound healing in tissue flap procedures involving extensive undermining. In late 2013 we began using a new lysine-based urethane tissue adhesive to hold the tissue planes in approximation, in the belief that this could reduce rates of early complications. To confirm our positive initial impressions we undertook a retrospective study of consecutive cohorts, 22 with adhesive and 28 from an earlier period, with a focus on early (30 day) complications and time to discharge. We documented a 50% reduction in the need for revisions (p=0.186, ns) and an 8 day reduction in average length of stay (p=0.022, significant). This is the first series report of the use of this fixation method in decubitus flap surgery and suggests that this is an approach which merits further evaluation.