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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.