- 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.