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Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study


Study design

Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol.


Tertiary Rehabilitation Hospital for SCI/D in Italy. Methods: Retrospective analysis of the medical records of adult individuals with SCI/D, who developed a PI after the first discharge from a Spinal Unit, underwent flap surgery for PI between July 2011 and January 2018. The statistical unit of analysis was the surgical intervention. Logistic regression analysis with robust standard errors was performed to assess risk factors of post-surgical complications.


434 surgical intervention records were included, for a total of 378 patients. The treated PIs were ischiatic in 56.2% of the cases, sacral in 32.5%, trochanteric in 15.7%, and 5.8% were in other sites. In 239 cases (55.1%) a histological diagnosis of osteomyelitis was confirmed. Minor complications occurred in 13.6% of interventions, while major complications were 3.9%. Sacral PI (OR = 2.55, 95%CI: 1.50–4.35) and muscular/musculocutaneous flap (OR = 2.12, 95%CI: 1.05–4.28) were significant factors associated with risk of post-surgical complications. After a mean follow-up of 21 months (range 12–36), six people (1.4%) had a recurrence. Patients with a recurrence had at least one comorbidity compared to 57% of people without recurrences (p = 0.036).


Our results demonstrate that complication and recurrence rates can be minimized when an established interdisciplinary and rehabilitation protocol is integrated in the clinical management.

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Fig. 1: Schematic description of the multidisciplinary treatment setting.
Fig. 2: Schematic description of peri-operative treatment protocol.
Fig. 3: Preoperative computerized pressure mapping in sitting position.
Fig. 4: Computerized pressure mapping in sitting position prior to discharge.

Data availability

The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


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We aknowlegde for their contribution in the multidisciplinary treatment protocol developement and the constant team work Montecatone wound care team (Alba Boriello, Carlo Golinelli, Luca Spallone, Debora Donattini, Rita Capirossi), the physiotherapists Chiara Poletti and Barbara Oles and the phisicians Carlo Frondini, Cristina Orlandini, Gaetano Vetrone, Romano Linguerri, Emilio Emili, Francesco Costa, Mahmoud Ganem Sadam. Also thanks to Tiziana Giovannini and Cecilia Baroncini for their contribution.

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RS was responsible for writing the paper, EM revised the paper, LN prepared tables and figures, SL and MB collected the data, ST and FFT analyzed the data, KC reviewed the paper.

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Correspondence to Rossella Sgarzani.

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All contributing authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this paper.

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We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research, that was approved by the Institutional Ethical Committee AVEC with the reference number 1000-2020-OSS-AUSLIM on 19th November 2020.

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Sgarzani, R., Maietti, E., Tedeschi, S. et al. Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study. Spinal Cord 61, 204–210 (2023).

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