Outcome Measures Associated with an Innovative Alternative to Managing Refractory Full-Thickness Pressure Injury

Background: Pressure injuries are increasingly prevalent, with approximately 2.5 million treated in the United States annually. The estimated annual cost is $9.1–11.6 billion. Many pressure injuries are refractory to treatment, thus leading to clinical, economic, and humanistic consequences. This project explores alternatives to existing best practices with the goal of reducing/preventing these consequences.

The Innovation: In 2014, the wound care team at the post-acute care facility reevaluated current treatment modalities associated with refractory full-thickness pressure injuries. The Advanced Tissue Closure™ (ATC™) was created. This surgical approach is designed to address difficult wounds, and its primary benefit is that it avoids additional metabolic stress on the patient associated with traditional flap surgery. Where traditional flap surgery may require patient transport to an operating room, general anesthesia, and prolonged recovery, the ATC™ is performed at the patient’s bedside in the post-acute care facility under local anesthesia. A skilled surgeon, trained in the procedure and administration of local anesthesia, is able to fully debride the associated wound, obtain bone and tissue for culture, maintain hemostasis, and close the refractory wound with a durable closure. The procedure is less invasive than flap surgery and is associated with less blood loss, yet more robust than graft surgery.

The ATC™ procedure is used in conjunction with the ATC™ program©, which is comprised of a standardized approach to follow-up. Most patients complete the ATC™ program© in eight weeks.

Outcomes: The ATC™ procedure and program© have been notably successful in wound resolution in patients who otherwise have been refractory to healing. Descriptive, comparative statistics will report time to closure, sustained resolution of pressure injury wound, postoperative length of stay, readmission rates, and cost of postoperative care as compared with national averages. Patient satisfaction is reported.

Additional Opportunity(ies): Continue to measure outcomes over time.