Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group

Authors

Samir S Awad
James D Stern
Cathy T Milne
Shane G Dowling
Ron Sotomayor
Elizabeth A Ayello
Leandro J Feo Aguirre
Basil Z Khalaf
Lisa J Gould
Michael N Desvigne
Abigail E Chaffin

Publication Date

5-1-2023

Journal

Advances in Skin & Wound Care

DOI

10.1097/01.ASW.0000922708.95424.88

PMID

37079788

PMCID

PMC10144322

PubMedCentral® Posted Date

4-17-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Pressure Ulcer, Surgical Wound Infection, Crush Injuries, bioscaffold, negative-pressure wound therapy, ovine forestomach matrix, pressure injury, surgical reconstruction

Abstract

OBJECTIVE: Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction.

METHODS: An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds.

RESULTS: Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention.

CONCLUSIONS: The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.