Experience of Surgical Treatment of Pressure Ulcers in Patients with Traumatic Spinal Cord Disease: Effectiveness and Risk of Complications

RELEVANCE One of the urgent issues in the complex treatment of patients with traumatic spinal cord disease is the treatment of pressure wounds. Despite the large number of suggested and applied methods, the results of surgical closure of pressure wounds remain unsatisfactory. The risks of developing purulent-septic wound complications and local circulatory disorders after surgery are high. The correct choice of the method of plastic surgery of bedsores can be made on the basis of a thorough analysis of the advantages and disadvantages of the main surgical methods. AIM OF THE STUDY To study the spectrum of complications after the use of various types of pressure ulcer plastic surgery in patients with traumatic spinal cord disease and to determine, based on the data obtained, the indications for their implementation. MATERIAL AND METHODS An analysis of surgical treatment of 151 patients was conducted, who underwent 215 planned surgeries for bedsores of various localizations. The surgical treatment included: plastic surgery using local skin-fat, skin-fascial and skin-muscle flaps. The frequency and spectrum of complications characteristic of each type of plastic surgery were analyzed. RESULTS Among all operated patients, the most frequent complications in the postoperative period were: partial or complete suture failure, wound infection, flap ischemia, lymphorrhea. In total, wound process complications were recorded in 39 cases (18%) out of 215 reconstructive plastic surgeries performed. The frequency of ischemic and infectious complications leading to complete or partial loss of flaps after the use of cutaneous-fascial flaps was 4.1%. In patients operated using skin-fat and skin-muscle flaps, relapses did not develop. CONCLUSION The method of choice for treating patients with extensive bedsores is reconstructive plastic surgery, which is based on the formation of skin-fat, rotational skin-fascial flaps with the provision of principles of tension-free plastics. At the same time, the issue of complications such as suture failure, wound infection, flap ischemia and lymphorrhea remains unresolved, which requires further scientific and practical research.