Objective: For patients with spinal cord injury (SCI) who undergo flap surgery to treat pressure injuries (PIs), the optimal duration of post-operative bedrest to promote healing and successful remobilization to sitting is unknown. At the study center, the minimum duration of post-operative bedrest was changed from 4 to 6 weeks. The purpose of this study is to compare outcomes of patients who underwent flap surgery using bedrest protocols of different duration.

Design: This was a retrospective review of all flap procedures completed at VA Puget Sound Health Care System from 1997 to 2016 to treat PIs in patients with SCI. Surgeries were excluded if they were not a flap (i.e. primary skin closure or graft), involved a non-pelvic region, or were a same-hospitalization revision of a prior surgery. The primary outcome of this investigation was the number of days between surgery and the first time the patient mobilized to sitting out of bed for 2 h with an intact surgical incision.

Methods: 190 patients received a total of 286 flap surgeries from 1994 to 2016. A chart review of each case was completed to determine the planned duration of bedrest (4- vs 6-weeks), first date of successful mobilization out of bed for 2 h, length of stay post-surgery, and occurrence of complications such as dehiscence or need for operative revisions.

Results: Among 286 primary surgeries, 171 surgeries used the 4-week protocol and 115 used the 6-week protocol. When compared to the 4-week protocol, patients treated with the 6-week protocol were slightly older, more likely to have a diagnosis of diabetes, and less likely to be current smokers. Healing was never achieved after 4 surgeries in the 4-week group and 2 surgeries in the 6-week group. With the analysis restricted to a single surgery per subject who achieved healing (109 treated with 4-week protocol and 75 with 6-week protocol), there was a significant difference in days until 2-h sitting: median 54 days for the 4-week protocol compared to 60 days for the 6-week protocol (p = 0.041). Up to about 60 days post-operatively, the 4-week protocol produced a greater proportion remobilized to sitting, and thereafter the proportion of patients successfully remobilized did not differ between protocols.

Conclusions: The 6-week protocol was not associated with improved remobilization outcomes (reduced rates of dehiscence or surgical revisions), and the 4-week protocol resulted in a significantly shorter time to remobilization to sitting for 2 h as well as a shorter length of stay. We did not identify any subgroup of patients that benefited from the longer protocol.

目的：对于接受皮瓣手术治疗压力性损伤（PI）的脊髓损伤（SCI）患者，术后卧床休息以促进愈合和成功重新坐位的最佳持续时间尚不清楚。在研究中心，术后卧床休息的最短时间从 4 周改为 6 周。本研究的目的是比较使用不同持续时间的卧床方案接受皮瓣手术的患者的结果。

设计：这是对 1997 年至 2016 年在 VA Puget Sound 医疗保健系统完成的用于治疗 SCI 患者 PI 的所有皮瓣手术的回顾性审查。如果不是皮瓣（即初次皮肤闭合或移植）、涉及非骨盆区域或者是先前手术的同一住院翻修，则排除手术。这项调查的主要结果是从手术到患者第一次在手术切口完整的情况下下床坐 2 小时之间的天数。

方法：从 1994 年到 2016 年，190 名患者总共接受了 286 例皮瓣手术。对每个病例​​进行了图表审查，以确定计划的卧床休息时间（4 周与 6 周）、成功下床活动 2 周的首次日期。 h，手术后的住院时间以及并发症的发生，例如裂开或需要手术修复。

结果：在 286 例初次手术中，171 例手术使用 4 周方案，115 例手术使用 6 周方案。与 4 周方案相比，接受 6 周方案治疗的患者年龄稍大，更有可能被诊断为糖尿病，并且目前吸烟的可能性较小。 4周组进行了4次手术，6周组进行了2次手术后，仍未实现愈合。由于分析仅限于每个获得治愈的受试者进行一次手术（109 例接受 4 周方案治疗，75 例接受 6 周方案治疗），直到 2 小时静坐的天数存在显着差异：4 小时静坐的中位数为 54 天。周方案与 6 周方案的 60 天相比 ( p = 0.041)。术后 60 天左右，4 周的方案使更多的患者重新活动到坐位，此后成功重新活动的患者比例在不同方案之间没有差异。

结论： 6 周方案与改善的复动结果（降低裂开或手术翻修率）无关，而 4 周方案则显着缩短了复动到坐 2 小时的时间以及更短的坐位时间。停留。我们没有发现任何受益于较长方案的患者亚组。