This case series was selected to highlight the complex aspects of surgical management of the sequelae of SP and is subject to selection bias. However, the issues presented are common to most patients encountered with complications of SP.
There was a limited scope of reporting due to lack of follow-up in the clinic. Many patients do not maintain active contact information to permit long-term staff follow-up when they fail to attend clinic. Many patients are intermittently jobless, homeless, and without access to a phone.
Reporter bias (ie, the inclination to select good results) is also a limitation. To minimize this bias, this case series was chosen to highlight dramatic surgical cases, most of which did not have a good outcome.
There is also the issue of employment of outdated dressing care. Due to lack of resources available to this patient population, less novel dressing regimens are often employed. Current products are more desirable and may decrease healing time, but these more expensive products are not typically available to these patients. As such, the authors rely heavily on older regimens.
Lastly, there is the limitation of resource availability. Most of the patients seen in the authors' clinic face an insurmountable issue, which is the lack of inpatient drug rehabilitation programs that accept patients with open wounds. Ideally, patients would transfer from the inpatient stay to a drug rehabilitation center. However, with open wounds, they are not candidates for most of these programs. This inflexibility in the current US medical system is a significant shortfall for this patient population.
Wounds. 2021;33(1):9-19. © 2021 HMP Communications, LLC