- 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;
-
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;
- ref:
Partial calcanectomy: an alternative to below knee amputation.
- 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
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