Plastic and Reconstructive Surgery
The Plastic Surgery department at the Swiss Paraplegic Centre (SPC) cares for complex wounds using a range of surgical procedures. Performing over 300 operations per year, it is Switzerland’s largest centre of excellence in this field.
Plastic and reconstructive surgery as a specialism is primarily concerned with resolving soft tissue defects (skin, fatty tissue, muscle, and some bones) and problematic scars which may be caused by accidents, the removal of tumours, complications following surgery, or chronic wounds. Specific surgical techniques are used in this process, in order to restore lost function and form, and to reintegrate the patient into everyday life.
A complete or partial loss of sensitivity, and spending long periods of time seated in the wheelchair, puts patients with plegia at particular risk of developing pressure sores (also referred to as decubitus or bed sores). In this process, pressure from bodyweight results in the skin and underlying fatty tissue dying off at exposed points over protruding parts of bone. Muscles and bones may also be affected in advanced cases.
The following areas of the body are most frequently affected:
- The coccyx
- The ischium
- The trochanter
- The ankle
- The foot
As long as the skin is still at least partially intact, scar-free healing is possible provided that the relevant point is completely relieved of pressure, i.e. through bed rest and proper wound treatment. In the event of deeper, extended tissue deterioration, surgical measures are generally required in order to reconstruct the tissue defect. An initial step of cleaning the wound, i.e. removing dead tissue (also referred to as debridement), is often required. The defect can be covered if the wound is clean. In most cases, this is achieved using a tissue transfer. This involves relocating healthy tissue to the defect and stitching it in with the objective of making the soft tissue as stable as possible, and therefore enabling the patient to be re-mobilised in a wheelchair, and to return to normal activities.
In parallel with surgical treatment, it is necessary to identify what caused the pressure sore, and to remedy that using appropriate measures such as seat adjustment, in order to prevent the pressure sore forming again.
Pressure sore prevention
Because it is recurring strain, primarily in the seat and sacrum area, which often results in thinning of the skin and fatty tissue, and because previous surgery can cause scarring, it is possible to try to prevent a pressure sore forming. A fatty tissue transplant can be used to pad soft tissue and improve the quality of the skin. However, this is not a suitable substitute for regularly reducing pressure and implementing other preventive measures; it only serves to improve the tissue situation on a localised basis.