Decubiti/Pressure Ulceration

- Discussion:
    - sacral, ischial, trochanteric, and heel ulcerations are most common;
    - preventative measures:
         - turning the patient ever 5 min q 2 hrs of relief may prevent pressure ulceration;
                   - a shift of weight in the wheelchair is required every 15 minutes;
         - air flow matress;
         - if neurologic deficit is present or if significant spine instability exists, rotating bed will help protect spine & decrease pulmonary and skin complications prior to surgical stabilization;
         - doughnut cushions should not be used, because they decrease blood flow to the area resting in the center of the donut;

- Wound Dressings:

- Debridement:
    - when skin necrosis occurs, it is likely that deep tissue necrosis has also occurred, and therefore deeper tissues are more extensively involved as well;
    - w/ sugical debridment, bony prominences and pressure points over sacrum, ischium and greater trochanter are leveled off;
    - goal of debridement is to reduce bacterial count and to reduce matrix metalloproteinases;
    - ischial ulceration:
            - w/ total ischiectomy, beware of bleeding from the sacrum and fistula formation from injury to the rectum or urethra;
            - gracilis flap
            - posterior thigh skin flap (medially based)
            - biceps femoris or semitendenosus muscle flap
            - gluteus maximus myocutaneous flap based superiorly
    - sacral:
            - gluteal rotation skin flap (based superiorly or inferiorly);
            - gluteus maximus myocutaneous flap;
    - trochanteric:
            - adjacent rotation flap (based anterior or posterior)
            - tensor fascia lata myocutaneous flap
            - vastus lateralis muscle turnover flap
    - heel:
            - flexor digitorum brevis flap;
            - abductor digitorum brevis flap;
            - references:
                   - Partial calcanectomy: an alternative to below knee amputation.
                   - Novel Posterior Splinting Technique to Avoid Heel Ulcers
- Pressure Ulcers: Standard of Care Conference

Medical Intelligence: Current Concepts: Geriatrics Pressure Ulcers Among The Elderly.

Partial calcanectomy: an alternative to below knee amputation.

Pressure sores and hip fractures

Modified Unna Boot and Pinch Grafting for Chronic Non-healing Venous Leg Ulcer

Enhanced healing of surgical wounds of the lower leg using weekly zinc oxide compression dressings.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 9, 2013 2:25 pm