Surgical methods for reducing early wound dehiscence after reconstruction surgery for pressure ulcer

Objective: Early postoperative wound dehiscence is the most common complication of pressure ulcers (PUs). The authors previously investigated the risk factors for this complication and reported that the main cause of early wound dehiscence was surgical site infection. This study aimed to improve the surgical method to decrease early postoperative wound dehiscence. Method: Patients with PUs between 2005 and 2022 were retrospectively investigated. In the control group, the ulcer surface was stained with methylene blue and debrided using the conventional method (surgical debridement). For comparison purposes, three test groups were established. In group 1, the ulcer surface was covered with hydrofibre with ionic silver, and debridement was performed using the covered debridement method. In group 2, debridement was performed using the conventional method and postoperative incisional negative pressure wound therapy (iNPWT) on the skin flap. Group 3 underwent both the covered debridement method and iNPWT. Patient data on: sex; age; body mass index (BMI); history of diabetes; smoking history; PU site; detection of meticillin-resistant Staphylococcus aureus in wound bacterial culture; serum albumin level; operation time; and ulcer size, were collected. Significant differences from the control group were determined for each factor. Results: A total of 60 patients underwent flap coverage (control group: 39 patients; group 1: six patients; group 2: eight patients; group 3: seven patients). There were no significant differences between the groups for each item except for albumin level and BMI. Rates of early wound dehiscence in the control group and groups 1, 2 and 3 were 15/39 (38.5%); 2/6 (33.3%; p=0.81); 2/8 (25%; p=0.47), and 0/7 (0.0%; p=0.049), respectively. Conclusion: A combination of methods may effectively reduce the incidence of early wound dehiscence.