Pressure Sore Flashcards
bed sores, or decubitus ulcers,
these wounds can occur anywhere on the body when there is
increased pressure or friction, shearing forces, or limb spasticity
T
The risk is even more pronounced in the SCI population, in which there is an estimated incidence of 20% to 30% in paraplegic and quadriplegic patients
T
no known direct evidence
linking urinary or fecal incontinence with the direct formation of
pressure-related injuries themselves.
T
Avoid bedside swab of wounds due to contamination; intraoperative deep cultures are superior for antibiotic tailoring
T
MRI may be indicated to evaluate extent of osteomyelitis
T
Spasm and contracture create shear forces contributing to
pressure injury development
T
Antispasmodic pharmacotherapy: badofen, diazepam,
dantrolene
T
Botulinum toxin improves function and reduces limb spasticity with minimal side effects
T
hydrogels during the debridement stage
T
foam and
low-adherence dressings for the granulation stage
T
hydrocolloid
and low-adherence dressings for the epithelialization stage
T
Diluted
sodium hypochlorite solution has been shown to be bactericidal with fibroblast preservation.
T
Hydrocolloid dressing has been associated with almost three
times more complete healing compared with the use of saline gauze alone
T
Honey-variable gel thickness and composition, minimal
risk, and low cost, with possible autolytic and antimicrobial
properties
T
Studies on sustained silver-releasing dressing demonstrated
a tendency for reducing the risk of infection and promoting
faster healing
T
use of alginates with hydrogel results in significantly
greater reduction in the size of stage 3 and 4 pressure injuries compared to hydrocolloid alone
F use of alginates with hydrocolloid results in significantly
greater reduction in the size of stage 3 and 4 pressure injuries compared to hydrocolloid alone
benefits of VAC
removal of infectious materials,36 reduced risk of compromise due to contamination,
the ability to solubilize necrotic tissue, reduced volume of exudate, increased granulation tissue, and decreased wound size
Contraindications to the use of NPWT include
exposed vessels or organs, nonenteric and unexplored fistulas, malignancy, and untreated osteomyelitis
A pressure injury itself is an indication of HBOT
F A pressure
injury itself is not an indication for HBOT
HBOT may be
used as adjunctive treatment for chronic refractory osteomyelitis within a pressure injury or a failed graft or flap.
T
The efficacy of platelet-derived growth factors, fibroblast growth
factor, and granulocyte macrophage colony stimulating factor in
improving complete pressure injury healing has not been well established.
T
There is some evidence that electrotherapy41 and whirlpool therapy4’
may help reduce the size and surface area of stage 2 to 4 pressure injuries
T
rate
of osteomyelitis
with 56% of primary injuries and 79% of recurrent
injuries
Avoid radical ostectomy for bony prominences WHY?
skeletal instability, excessive bleeding, and
pressure point redistribution
There is no reported difference in success using myocutaneous
compared to fasciocutaneous flaps
T
Recurrence rates of 19% to 33% have been
reported for ischial pressure injuries after flap reconstruction
T
Tensor fascia lata (TFL) may be considered, but it may be too thin
distally
T
Consider flaps that can be readvanced subsequently: for example
gluteal rotation or V-Y hamstring. for ischium
T
For Sacrum
Most common musculocutaneous flap is based on gluteus maximus muscle. Can be superior or inferiorly based, with ability to
rotate, advance, or turnover.
A fasciocutaneous flap or partial gluteus muscle may be needed in ambulatory patient as gluteus maximus muscle is not expendable.
T
Recurrence rates 17% to 21% depending on flap choice
T
Trochanter
Flap reconstruction most commonly TFL, but pedicled ALT flap
is also an option
TFL blood supply consistent from underlying TFL muscle, but
distal part of flap is random blood supply that may need to be
delayed
T
Ifthere is a SCI below L3, the TFL can be sensate via Ll-L3 by way
of the lateral femoral cutaneous nerve
T
Heels may require lifelong wound care, free flap coverage, or
amputation depending on patient functional status and comorbid
state
T
VTE has been
reported as high as 11% in the acute SCI population, despite
receiving VTE prophylaxis
T
pallor. Patients with lesions above T6 are particularly susceptible to autonomic dysrefelxia
T
Perioperative blood transfusion is RISK FACTORS FOR POSTOPERATIVE
COMPLICATIONS
T
Patients who develop a pressure injury in an ICU setting have
in-hospital mortality rates as high as 48%
T
Age above
65 years, diabetes, and total functional dependency were associated with increased mortality risk
T
