Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach?

Marieke Braafhart, Henricus E.W. de Laat*, Till Wagner, Emmy van de Burgt, Stefan Hummelink, Dietmar J.O. Ulrich

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Introduction: There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction
during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. Objective: The aim of this study was to compare the results of single stage surgery and two-stage surgery on the
PU recurrence rate and other important post operative complications.
Method: A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis.
Results: The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration
to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial)
flap failure did not differ significantly between both groups, apart and in total.
We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362.
Conclusions: There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery.
The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications
for the patient, family, health care providers and the health care system.
Original languageEnglish
Article numberJTV 393
Pages (from-to)319-323
Number of pages5
JournalJournal of Tissue Viability
Issue number4
Publication statusPublished - 14-Aug-2020


  • Pressure ulcers SCI individuals Surgical reconstruction Stage reconstruction Two-stage reconstruction

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