Abstract
Study design
Systematic review and meta-analysis.
Objectives
To identify, critically appraise, and synthesize research findings on non-sensate versus sensate flaps among individuals with spinal cord disease and pelvic pressure ulcers, with pressure ulcer recurrence as primary outcome.
Methods
PubMed, EMBASE, and Cochrane CENTRAL were screened for relevant studies. Data on surgical characteristics, ulcer recurrence, and sensory outcomes were retrieved and tabulated. Risk of bias was assessed with MINORS. The level of evidence was evaluated with GRADE. Meta-analysis was performed when possible.
Results
Meta-analysis of 1794 non-sensate locoregional reconstructions indicated a recurrence rate of 34% within several years (95% CI, 27–42). Twenty-one articles provided data on 75 sensate reconstructions, performed in 74 individuals. Meta-analysis of the sensate reconstructions indicated a recurrence rate of 1% (95% CI, 0–8). Sensate reconstructions were not associated with an increase of wound complications (19%; 95% CI, 7–40) compared with non-sensate ones (34%; 95% CI, 27–42). A very low level of evidence was determined with use of GRADE.
Conclusion
Although of a very low-level, the present evidence suggests that restoration of sensory innervation may be an effective intervention for the prevention of pressure ulcer recurrence among individuals with spinal cord disease. A prospective RCT is needed to confirm or refute the results of this systematic review.
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Acknowledgements
We want to thank our clinical librarian Faridi van Etten-Jamaludin for her help constructing the search strategy. We want to thank our statisticians Susan van Dieren and Rebecca Holman for their advice on how to approach statistical analysis and present the data.
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Sponsors did not have any influence in the study design, in the collection, analysis and interpretation of data; in the writing of the paper; and in the decision to submit the paper for publication.
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All authors have made substantial contributions to the design of the study and interpretation of data and helped draft the final paper, and revised it critically in equal measure as a group effort. All authors approve the final version to be published and agree to be accountable for all aspects of the work related to its accuracy and integrity. PRZ also formulated the first concept for this paper and its methodology, constructed the search strategy together with a clinical librarian, performed the systematic review, helped with data extraction, risk of bias assessment and OHAT assessment of the body of evidence, and helped with the construction of the tables, created the figures and illustrations, and devised the initial outlines of the paper. RWAV also performed the systematic review as a second reviewer and helped with data extraction and risk of bias and body of evidence assessment and constructed the tables. OL and MCO also provided their clinical perspective as plastic surgeons. Professor MAB also acted as study supervisor.
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MAB reports institutional grants from J&J/Ethicon, Acelity/KCI, Allergan/LifeCell, Ipsen, Baxter, Mylan, Bard, and is advisory board member of J&J/Ethicon, Acelity/KCI, Bard, and Allergan/LifeCell, for research and expertize outside the submitted work. The authors declare that there are no conflicts of interest related to this work.
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Zwanenburg, P.R., Verdijk, R.W.A., Lapid, O. et al. A Systematic review and meta-analysis of sensate versus non-sensate flaps for the prevention of pressure ulcer recurrence among individuals with spinal cord disease. Spinal Cord 59, 463–473 (2021). https://doi.org/10.1038/s41393-020-00590-5
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DOI: https://doi.org/10.1038/s41393-020-00590-5
