Background: Pressure injuries are a burden to patients and the health care system, and negative pressure wound therapy (NPWT) is a widely used treatment.
Purpose: This study sought to assess the effect of stool management followed by surgical debridement and surgical closure combined with NPWT in the treatment of posterior trunk pressure injuries.
Methods: A retrospective descriptive study was conducted in patients with stage 3 or 4 posterior trunk pressure injuries by reviewing electronic health records. The collected variables included sex, age, height, weight, initial underlying disease leading to being bedridden, stage and anatomical location of pressure injury, stool frequency, pathogens, number of NPWT applications, complications related to surgical closure, outcome, and treatment time. Fasting and enema were used to reduce the frequency of defecation, followed by surgical debridement and surgical closure combined with NPWT.
Results: Among the 63 eligible patients, 35 were male and 28 were female (average age, 72.3 ± 11.3 years). The patients' weight before fasting and after fasting showed no significant difference (62.6 ± 11.2 kg vs 61.6 ± 10.2 kg; 95% confidence interval, -2.78-4.76; P = .60). Stage 3 and stage 4 accounted for 33 (52.4%) and 30 (47.6%) pressure injuries, respectively. There were 36 (57.1%) pressure injuries located on the sacrum, and the remaining 27 (42.9%) were located in the ischia. Underlying causes for being bedridden were cardiopulmonary insufficiency (n = 23; 36.5%), severe brain damage and cerebrovascular accident (n = 19; 30.2%), spinal cord injury (n = 12; 19.0%), and others (14.3%). The wound closure rate was 96.8% (n = 61), with a mean hospital stay of 22.3 days. These patients underwent 1 to 3 cycles of NPWT before surgical wound closure. Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa were the most common pathogens. The complications related to surgical closure (defined as complications that occurred from surgical closure until 30 days later) occurred in 7 patients (11.1%); 3 patients (4.8%) experienced a pressure injury recurrence.
Conclusion: The treatment approach reported here was effective in these patients with posterior trunk pressure injuries. A satisfactory cure rate, manageable complications, and rare recurrence were achieved. Parenteral nutrition after fasting maintained patients' weight without significant loss. Prospective randomized controlled trials involving larger samples and longer follow-up times are needed.