gms | German Medical Science

44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 18. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

12.09. - 14.09.2013, Münster

Role of Plastic Surgery in the Treatment of Complex Wounds. Experience of the University Hospital in São Paulo, Brazil

Meeting Abstract

Search Medline for

  • presenting/speaker Marcus Ferreira - University of São Paulo, Plastic Surgery, São Paulo, Brazil

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Münster, 12.-14.09.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 50

doi: 10.3205/13dgpraec152, urn:nbn:de:0183-13dgpraec1520

Published: September 10, 2013

© 2013 Ferreira.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: The increased incidence of wounds is recognized as an unexpected side effect of a longer expectation of life and better medical treatments for usual diseases like diabetes. A special group is known to be difficult to heal: the complex wounds. Some criteria were adopted to define them:

extensive loss of integument;
inclusive of all layers of the skin;
presence of necrotic tissue and clinical superficial infection, and
association with systemic morbidities (ex. diabetes) [1].

In São Paulo, since 2006 the University Hospital established a center for the treatment of such complex wounds under the supervision of plastic surgery.

Objective: To review and study six years of the medical activity of the Wound Center and the results after the introduction of negative pressure therapy (VAC).

Method: We reviewed the data from 2006 to 2011, including 2456 patients who were already inbed in one of the almost 2000 beds of the hospital and in the emergency ward. Plastic surgery and nursery were called to interconsultation by the main doctor of the patient to give an opinion, orientation and eventually treatment of the wound.

Results: The most frequently seen wounds were pressure sores (807 cases); loss of skin in trauma of the lower limb (724 cases), complications of many different surgical procedures (384 cases) and necrotizing wounds with infection (Fournier’s) (264 cases). Diabetic wounds in lower limbs were also seen. From the 2456 cases, 73% (1791 patients) needed surgical procedures (two in average) done by the plastic surgery, including extensive and often repeated debridements and reconstruction with skin grafts (823 cases), pedicled flaps (309 cases) and even free flaps (80 cases). Negative Pressure therapy was frequently used (during one to three weeks) after the debridement, replacing other dressings (1470 cases) or over a skin graft (422 cases). The results were quite good with closure of the wound in most cases. Plastic Surgery procedures had only 153 cases of complications (8.5%). The most impressive contribution of this approach apart of the good results was the reduced time of hospitalization, most patients were cured in less than one month. There were also clear reduction of costs due to less need of hospital beds and diminished use of antibiotics.

Conclusion: There was no doubt that the use of negative pressure associated to reconstructive plastic surgery contributed much to the appointed success of treatment but it should be emphasized that it was never, always as part (usually for 2 to 3 weeks) of the plastic surgery treatment. Contribution of a multidisciplinary team was essential for the success of treatment.


Ferreira MC, et al. Complex wound. Clinics. 2006;61:571-8.