Surgical Therapy for Complex Pelvic Pressure Injuries: A Review of Outcomes for Five Consecutive Years and a Proposal for a Navigator in the Care Pathway

Abstract

Introduction. An advanced pelvic PI is a challenging problem that requires care from multiple disciplines. Objective. This study is a critical evaluation of wound recurrences after surgical repair, and an analysis of factors that may contribute to surgical failures. This study also provides a literature review of pelvic PIs and proposes how a navigator embedded in the wound care department could play a role in decreasing surgical failures. Methods. A retrospective cohort study of 33 consecutive surgeries for closure of complex pelvic PIs in 22 patients was conducted. Results. Recurrences developed in 17 of 33 surgeries (52%). Recurrences were seen most frequently in those undergoing simultaneous repair of 2 sites and those who had undergone prior surgeries. Conclusions. Long-term healing after repair of complex pelvic PIs remains a challenge, especially in certain high-risk populations. A significant portion of recurrences develop after a period of healing, so identifying and addressing factors that lead to wound breakdown following hospital discharge is a critical area of care improvement. A navigator care coordinator within the wound care department may play an important role in preventing wound recurrences.