Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol

Gregory Nicolas; Joao Ferreira; Daniel Valente; Laielly Abbas; Marita Saliba; Dimas Milcheski; Araldo Monteiro Junior; Rolf Gemperli

doi:10.1016/j.bjps.2023.09.021

Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol

J Plast Reconstr Aesthet Surg. 2023 Sep 15:92:207-211. doi: 10.1016/j.bjps.2023.09.021. Online ahead of print.

Authors

Gregory Nicolas¹, Joao Ferreira², Daniel Valente², Laielly Abbas², Marita Saliba³, Dimas Milcheski², Araldo Monteiro Junior², Rolf Gemperli²

Affiliations

¹ Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil. Electronic address: Gregory.nicolas@ijcrcentral.com.
² Department of Plastic & Reconstructive Surgery, Hospital das Clínicas of the University of São Paulo, Brazil.
³ Faculty of Medicine, University of Balamand, Lebanon.

PMID: 38552404
DOI: 10.1016/j.bjps.2023.09.021

Abstract

Background: The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV), mainly due to the long-term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair.

Objectives: To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID-19. Developing a well-established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID-19 pandemic.

Methods: Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID-19 from May 2020 to August 2020 (4 months). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable-adjusted logistic regression was made in order to identify risk factors for complications.

Results: Thirty-eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0 mg/dl (p = 0,01), leukocyte levels higher than 11.000/mm³ (p = 0,1), and C Reactive protein levels higher than 142 mg/dl (p = 0,06) at the time of reconstruction and bilateral flaps were independent factors for complications.

Conclusion: Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital-acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID-19 pandemic.

Keywords: Coronavirus infections; Plastic surgery; Pressure injury; Surgical flaps; Wounds and injuries.