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Undermining incision and healing of deep pressure ulcers: A prospective cohort study of pressure ulcers by the J apanese N ational H ospital O rganization
Author(s) -
Nagase Takashi,
Iizaka Shinji,
Kato Hirofumi,
Nakagami Gojiro,
Kaitani Toshiko,
Machida Masafumi,
Oshima Hideo,
Ochiai Hiroko,
Bito Seiji,
Sanada Hiromi
Publication year - 2013
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/wrr.12057
Subject(s) - medicine , granulation tissue , prospective cohort study , observational study , surgery , cohort , cohort study , surgical incision , wound healing
Undermining is one of the most challenging complications of deep pressure ulcers. Recommendations in most guidelines are based only on expert opinions. Here, we examined the relationship between surgical incision of the undermined space and pressure ulcer healing through a Japanese multicenter prospective cohort study. A total of 162 patients with undermining in 40 national hospitals in J apan were enrolled from J uly 2007 to J une 2009. The incision group included 39 patients (24.1%) whose undermining was surgically incised during the observational period. Their 4‐week follow‐up data on pressure ulcer severity and areas of healthy granulation tissue were recorded as outcome variables using the DESIGN‐R pressure ulcer assessment tool. The 4‐week follow‐up was restarted after the incision in the incision group. The outcome variables over time were compared between the two groups using a linear mixed model with or without adjustment for demographic and other variables. The incision group showed more rapid improvement in the total and granulation DESIGN‐R scores compared with the nonincision group ( p < 0.001 and p = 0.007, respectively, in the crude models). This study may provide the first considerable evidence to support that surgical incision of undermining may promote healing of deep pressure ulcers.