Bedsores are injuries to the skin and the tissue beneath it caused by sustained pressure. The risk of developing them is higher in people with reduced mobility, such as those who are bedridden or wheelchair-bound. Some of them require surgery. In these cases, patients must be hospitalised for an average of one month to ensure proper recovery. The Institut Guttmann and the El Carme social and healthcare centre have initiated a joint programme for the post-surgical management of people with pressure ulcers (PU), aiming to optimise healthcare resources and guarantee continuity of care with high quality care.  

Recent studies indicate that 1 in 3 people with a spinal cord injury (SCI) have a PU, as SCI increases the predisposition to ulcers and makes them more difficult to heal. Sometimes they can develop over a few hours or days. "A common problem is that of people with a spinal cord injury who are hospitalised for a primary infection for 2 or 3 days and return home with an ulcer, or people with reduced mobility who live alone, get older and develop the lesion," explains Caridad Fernández, a nurse in the Specialised Assessment and Support Team (EASE) at the Institut Guttmann. Most PUs recover with treatment, but some never recover completely and, if they progress to serious infections, they can be life-threatening. "In addition, they greatly affect the quality of life, because the person must remain in bed for a long time and in certain positions, entailing a psychological, physical and social burden," adds Fernández. 

In the most severe cases, plastic surgery is necessary to facilitate complete healing. In 2024, the Institut Guttmann -a monographic hospital specialising in neurorehabilitation and the only CSUR Centre (Centres, Services and Reference Units of the National Health System) in Catalonia for the treatment of patients with complex spinal cord injury - carried out 26 interventions of this type. 

  After the surgery, patients are admitted to hospital for an average of 37 to 44 days. "These are post-surgical periods in which the person cannot carry out any rehabilitation activities, as they have to do absolute bed rest for the first three weeks," says Mireia Navarro, a nurse at the EASE. With the new programme, patients are now operated on at the Institut Guttmann, where they spend the first 10 days post-operatively, and are then transferred to the Centro Sociosanitario El Carme until they are definitively discharged. 

The initiative bean in May 2024, and since then 5 people (4 with paraplegia and 1 with tetraplegia) have entered the programme. In all cases the evolution has been very favourable, with a stay of between 11 and 13 days at the Institut Guttmann and between 16 and 21 days at the BSA intermediate care centre.  

Ensuring quality care 

The Centro Sociosanitario El Carme specialises in intermediate care and has a Complex Wounds Unit, accredited by the National Group for the Study and Advice on Pressure Ulcers and Chronic Wounds (GNEAUPP). "This is the best care system for managing demand and guaranteeing quality patient care for treating pressure injuries," says Mireia Fernández, a nurse in charge of the BSA's Complex Wounds Unit.   

Before starting the programme, joint sessions were held between the two centres, in which the team at the El Carme received training on SCI, cover surgery - which is how the UP intervention is known - and the specific postoperative care needed by these patients. "The good results are based on the multidisciplinary work and the expertise of the two centres, as people with spinal cord injury need very specific care," says Navarro. 

During the stay at El Carme, both Dr. Xènia Garrigós, a plastic surgeon at the Institut Guttmann, and the EASE team visit the patient to ensure continuity of care. Once the patient has been discharged, if the case requires it, home follow-up is also carried out. The experience is receiving very good feedback from patients and professionals from both organisations in terms of health and satisfaction.