Clinical audit on surgical management of pressure ulcer in the plastic surgery unit at Muhimbili National Hospital

Abstract

ABSTRACT Background: Pressure ulcers, caused by prolonged pressure or shear in immobile or critically ill patients, pose a major healthcare challenge, leading to complications and higher costs. Surgical management is crucial for advanced cases, yet data on techniques and outcomes, particularly in Sub-Saharan Africa, is limited. This audit evaluates surgical interventions for pressure ulcers at Muhimbili National Hospital (MNH), aiming to improve care strategies and address a critical knowledge gap. Objective: To assess the surgical management of pressure ulcers in the Plastic Surgery Unit at Muhimbili National Hospital, with the aim of improving patient outcomes and optimizing care practices. Methodology: This clinical audit was conducted at the Plastic and Reconstructive Surgery Unit, Muhimbili National Hospital, from November 2022 to August 2024. It retrospectively reviewed surgical management of pressure ulcers in adult patients. Data was collected via patient records, analyzed using SPSS after obtaining ethical clearance obtained from MUHAS and MNH. Results: This audit of 17 pressure ulcer patients at Muhimbili National Hospital revealed a median age of 62 years, predominantly affecting older males (58.8%), with 52.9% having Grade III ulcers mainly in the sacral region (41.2%). Most patients were non-ambulant (70.6%), indicating a need for targeted care. Seven surgical techniques were employed, with the gluteal myocutaneous V-Y flap being the most common (29.4%). Significant associations were found between ulcer location and severity in surgical technique selection (p=0.047 and p=0.045), while age, gender, and mobility status did not significantly impact choices. Postoperative complications occurred in 29.4% of patients, particularly high in those treated with the reverse sural flap (100% complication rate), and the median hospital stay was 9 days, underscoring the necessity for effective postoperative care. Conclusion: This audit reveals a significant prevalence of pressure ulcers among older male patients, primarily affecting those who are non-ambulant. The findings highlight the need for tailored surgical interventions, particularly the gluteal myocutaneous V-Y flap, while emphasizing the importance of postoperative care to reduce complications. Targeted strategies are essential for managing pressure ulcers in high-risk populations to improve patient outcomes.