• Journal of Korean Academy of Fundamentals of Nursing
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• v.6 no.2
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• pp.267-276
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• 1999

The purpose of this study was to identify risk factors predictive of alterations in skin integrity during the intraoperative period. The predictive risk factors were studied for intraoperative pressure sores from December 1998 through January 1999. A sample of 220 patients was selected from the operating room schedule of a University Hospital in Pusan. There were two criteria in including patients : the operation lasted longer than 2 hours and the absence of skin break-down according to NPUAP criteria. The data were analized by SPSS/PC, Stepwise multiple logistic regression was used to identify the variables which were predictive of alterations in skin integrity. Of the 220 patients studied, 41 patients (18.6%) developed stage 1 pressure sores in the immediate postoperative period. In relation to skin changes, three independent variables emerged from the stepwise multiple logistic regression as being significant (p<0.05). Factors predictive of pressure sore formation included low serum albumin(p=0.000), prone position while undergoing surgery(p=0.0004), time on the operating table(p=0.0165). Among the intrinsic factors, serum albumin was the most significant causal factor in pressure sores development in the intra-operative period. Pressure and shearing force were the most significant extrinsic factors in pressure sores development. From the results of this study we concluded that the primary nursing goal is the maintenance of the proper patient' position during the intraoperative period. Also imperative for sore prevention is the reduction of surgery time and improving preoperative nutritional status.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.277-282
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• 2009

Purpose: The vegetative state is a clinical condition with complete unawareness of self and environment, but with preservation of brain - stem functions. Vegetative patients may have nosocomial infections in their wounds, like pressure sores and infected craniums after cranioplasties. Usually flap surgery is necessary for those wounds, but decision of undergoing surgery is difficult because of various adverse conditions of vegetative patients. We share our experience of several successful flap surgeries in vegetative patients, and evaluate obstacles and requirements to get satisfactory results. Methods: From December 2005 to September 2008, a total of 4 vegetative patients underwent surgeries. In 2 patients with infected artificial craniums, scalp reconstructions with free flaps were performed. In other 2 patients with huge pressure sores with sepsis, island flap coverage of wounds was done. Retrospective study was done on hospital day, vegetative period, number of surgeries done, underlying diseases, causative bacteria, and contents of informed consent. Results: Mean hospital day was 14 months and mean vegetative period was 17.5 months. Patients underwent average of 4.5 surgeries under general anesthesia. There were several underlying diseases like hypertension, DM, CHF and chronic anemia. MRSA(Methicilin - resistant Staphylococcus Aureus) was cultured from every patient's wounds. Informed consent included a warning for high mortality and a need of attentive familial cooperation. Conclusion: There are three requirements for doing flap surgeries in vegetative patients. First, to prevent aggravation of brain damage and underlying diseases by general anesthesia, multidisciplinary team approach is needed. Second, operation should be beneficial for prolonging patient's lifespan. Third, because postoperative care is very difficult and long hospitalization is needed, detailed informed consent and highly cooperative attitude of family should be confirmed before operation.