Chronic Pressure Ulcers Research Articles

Polymicrobial Osteomyelitis in a Patient With Isolation of Trueperella bernardiae: A Case Report and Literature Review

Background: Trueperella bernardiae is a Gram‐positive rod that has been described as an opportunistic pathogen in immunocompromised patients. In a significant number of documented cases, infections with Trueperella bernardiae have been associated with polymicrobial infections, which highlight the fact that important bacteria–bacteria relations might be involved in the natural course of these infections, especially in patients with chronic disease courses and a history of multiple antibiotic treatments.Case Presentation: We present a case of a 24‐year‐old woman with a 3‐year history of a chronic pressure ulcer on the right foot associated with varus and cavus deformity. As per relevant medical history, she was positive for multiple wound healing sessions with wound debridement and a large number of antibiotic treatments with minimal improvement. Microbiological cultures were taken from the wound, and a soft tissue infection diagnosis was initially made. Empirical treatment was initiated with levofloxacin. At 48 h, cultures were positive for Providencia stuartii, Pseudomonas aeruginosa, Proteus penneri, Streptococcus agalactiae, and Trueperella bernardiae, and the susceptibility test was performed. Three weeks later, the symptoms progressed to purulent exudate of the wound and foul‐smelling with the positive probe‐to‐bone test. Diagnosis was changed to polymicrobial osteomyelitis, and antibiotic therapy with ciprofloxacin and trimethoprim‐sulfamethoxazole was prescribed for a 4‐week course of treatment, achieving the complete remission of symptoms.Conclusions: Trueperella bernardiae represents an emerging bacterium that can be isolated in various clinical presentations. On osteoarticular infections, the presence of comorbidities, mobility limitations, and a history of multiple antibiotic treatments may be determinant. Their isolation as part of polymicrobial infections highlights relevant interspecies interactions. Research is still lacking in determining standardized methodologies for susceptibility testing and specific clinical breakpoints to guide clinical decisions.

Quantification of muscle fiber malformations using edge detection to investigate chronic muscle pressure ulcers.

Microscopy of regenerated tissue shows different morphologies between the healing of acute wounds and chronic wounds. This difference can be seen manually by biologists, but computational methods are needed to automate the characterization of morphology and regenerative quality in regenerated muscle tissue. From the detected edge segments, we computed several imaging biomarkers of interest, such as median tortuosity, number of edge segments normalized by area, median edge segment distance and interquartile range of orientation angles of edge segments of the microscope images of successful and unsuccessful muscle regeneration. We observed that muscle fibers in saline-treated pressure ulcers had a larger interquartile range of orientation angles of the edge segments (p = 0.05) and shorter edge segment distances (p = 0.003) compared to those of acute cardiotoxin injuries. Our edge detection method was able to identify statistically significant differences in some of the imaging biomarkers between saline-treated pressure ulcers and cardiotoxin injuries, suggesting that chronic pressure ulcers have increased muscle fiber malformations compared to cardiotoxin injuries.

(102) EVIDENCE-BASED STRATEGIES FOR PREVENTING LOWER-LIMB COMPLICATIONS SECONDARY TO PROLONGED USE OF THE DORSAL LITHOTOMY POSITION

Abstract Introduction Patient positioning at the time of surgery plays a critical role in determining patient outcomes. Specific to patients undergoing genital gender-affirming surgery (gGAS), these patients are required to be placed in the lithotomy position to access the pelvis and perineum for their procedures. Lower-extremity injury due to prolonged surgical time in the lithotomy position can have significant post-operative morbidity affecting patient outcomes. This risk is increased in patients undergoing gGAS procedures due to high surgical complexity and especially long operative times as compared to other surgical procedures. Careful attention must be placed on the patient’s specific position perioperatively due to potential injury risk. Prolonged stasis can cause injuries ranging from mild soft-tissue injuries which rapidly resolve, such as mild pressure injuries to bony prominences, to severe injuries including pressure ulcers, nerve injuries, rhabdomyolysis, and compartment syndrome. These complications can have lasting impact on the patient, with associated morbidity and mortality risk, and can also impact healthcare systems through additional dollars spent caring for patients who suffer these complications and their associated rehabilitation, and legal recourse on behalf of the patient who suffered these severe complications. Objective Our study aimed to describe our technique for preventing lower extremity injuries in the dorsal lithotomy position, and to evaluate our positioning-related post-operative complications and rates. Methods We describe our technique for lower-limb positioning in the dorsal lithotomy position, with an emphasis on injury prevention for patients undergoing gGAS. We assessed positioning-related outcomes and complications among patients undergoing gGAS for prolonged periods (>300 minutes) in the lithotomy position between January 2017 to March 2023. Results A total of 227 patients underwent 310 gGAS procedures were included in our study (156 masculinizing: 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes +/- 156.5 minutes (SD) (Range 300–1095 minutes) (Figure 1a). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-operatively. No (0%) patients had major or chronic complications including chronic nerve injury, pressure ulcers, rhabdomyolysis or compartment syndrome (Figure 1b). Our patient positioning employs the use of ½ inch foam placed to surround the lower extremity, ensuring that all at-risk areas of compression are adequately protected when placing the patient’s leg in the Allen stirrups whilst in the lithotomy position (Figure 1d). In addition, a perioperative list is also utilized with regular leg checks every 1.5–2 hours with nursing documentation and also, ensuring patients are able to move their lower extremities without any pain post-operatively (Figure 1c). Conclusions Our study is the first to describe a specific technique and outline strategies for protecting the lower extremities to prevent injuries in patients undergoing prolonged surgical procedures in the lithotomy position. The low complication rates associated with our technique warrants attention to further refine this technique, and, to integrate these strategies into operating-room programs across diverse specialties. Disclosure No.

(272) Evidence-Based Strategies for Preventing Lower-Limb Complications Secondary to Prolonged use of the Dorsal Lithotomy Position

Abstract Introduction Patient positioning at the time of surgery plays a critical role in determining patient outcomes. Specific to patients undergoing genital gender-affirming surgery (gGAS), these patients are required to be placed in the lithotomy position to access the pelvis and perineum for their procedures. Lower-extremity injury due to prolonged surgical time in the lithotomy position can have significant post-operative morbidity affecting patient outcomes. This risk is increased in patients undergoing gGAS procedures due to high surgical complexity and especially long operative times as compared to other surgical procedures. Careful attention must be placed on the patient’s specific position perioperatively due to potential injury risk. Prolonged stasis can cause injuries ranging from mild soft-tissue injuries which rapidly resolve, such as mild pressure injuries to bony prominences, to severe injuries including pressure ulcers, nerve injuries, rhabdomyolysis, and compartment syndrome. These complications can have lasting impact on the patient, with associated morbidity and mortality risk, and can also impact healthcare systems through additional dollars spent caring for patients who suffer these complications and their associated rehabilitation, and legal recourse on behalf of the patient who suffered these severe complications. Objective Our study aimed to describe our technique for preventing lower extremity injuries in the dorsal lithotomy position, and to evaluate our positioning-related post-operative complications and rates. Methods We describe our technique for lower-limb positioning in the dorsal lithotomy position, with an emphasis on injury prevention for patients undergoing gGAS. We assessed positioning-related outcomes and complications among patients undergoing gGAS for prolonged periods (>300 minutes) in the lithotomy position between January 2017 to March 2023. Results A total of 227 patients underwent 310 gGAS procedures were included in our study (156 masculinizing: 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes +/- 156.5 minutes (SD) (Range 300–1095 minutes) (Table 1a). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-operatively. No (0%) patients had major or chronic complications including chronic nerve injury, pressure ulcers, rhabdomyolysis or compartment syndrome (Table 1b). Our patient positioning employs the use of ½ inch foam placed to surround the lower extremity, ensuring that all at-risk areas of compression are adequately protected when placing the patient’s leg in the Allen stirrups whilst in the lithotomy position (Figure 1). In addition, a perioperative list is also utilized with regular leg checks every 1.5–2 hours with nursing documentation and also, ensuring patients are able to move their lower extremities without any pain post-operatively (Figure 2). Conclusions Our study is the first to describe a specific technique and outline strategies for protecting the lower extremities to prevent injuries in patients undergoing prolonged surgical procedures in the lithotomy position. The low complication rates associated with our technique warrants attention to further refine this technique, and, to integrate these strategies into operating-room programs across diverse specialties. Disclosure No.

(138) Evidence-based Strategies for Preventing Lower-limb Complications Secondary to Prolonged Use of the Dorsal Lithotomy Position

Abstract Introduction Patient positioning at the time of surgery plays a critical role in determining patient outcomes. Specific to patients undergoing genital gender-affirming surgery (gGAS), these patients are required to be placed in the lithotomy position to access the pelvis and perineum for their procedures. Lower-extremity injury due to prolonged surgical time in the lithotomy position can have significant post-operative morbidity affecting patient outcomes. This risk is increased in patients undergoing gGAS procedures due to high surgical complexity and especially long operative times as compared to other surgical procedures. Careful attention must be directed to the patient’s specific position intraoperatively due to significant risk of potential injury with prolonged surgeries. Prolonged stasis can cause injuries ranging from mild soft-tissue injuries which rapidly resolve, such as mild pressure injuries to bony prominences, to severe injuries including pressure ulcers, nerve injuries, rhabdomyolysis, and compartment syndrome. These complications can have lasting impact on the patient, with associated morbidity and mortality risk, and can also impact healthcare systems through additional dollars spent caring for patients who suffer these complications and their associated rehabilitation, and legal recourse on behalf of the patient who suffered these severe complications. Objective Our study aimed to describe our technique for preventing lower extremity injuries in the dorsal lithotomy position, and to evaluate our positioning-related post-operative complications and rates. Methods We describe our technique for lower-limb positioning in the dorsal lithotomy position, with an emphasis on injury prevention for patients undergoing gGAS. We assessed positioning-related outcomes and complications among patients undergoing gGAS for prolonged periods (>300 minutes) in the lithotomy position between January 2017 to March 2023. Results A total of 227 patients underwent 310 gGAS procedures were included in our study (156 masculinizing:154 feminizing gGAS procedures). Mean operative time was 495.5 minutes +/- 156.5 minutes (SD) (Range 300–1095 minutes) (Table 1a). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-operatively. No (0%) patients had major or chronic complications including chronic nerve injury, pressure ulcers, rhabdomyolysis or compartment syndrome (Table 1b). Our patient positioning employs the use of ½ inch foam placed to surround the lower extremity, ensuring that all at-risk areas of compression are adequately protected when placing the patient’s leg in the Allen stirrups whilst in the lithotomy position (Figure 1). In addition, a perioperative list is also utilized with regular leg checks every 2 hours with nursing documentation and also, ensuring patients are able to move their lower extremities without any pain post-operatively (Figure 2). Conclusions Our study is the first to describe and illustrate specific techniques, and outline strategies, for protecting the lower extremities to prevent injuries in patients undergoing prolonged surgical procedures in the lithotomy position. The low complication rates associated with our technique warrants attention to further refine this technique, and, to integrate these strategies into operating-room programs across diverse specialties. Disclosure No.

Stable closure of acute and chronic wounds and pressure ulcers and control of draining fistulas from osteomyelitis in persons with spinal cord injuries: non-interventional study of MPPT passive immunotherapy delivered via telemedicine in community care.

Micropore particle technology (MPPT) is a topical wound treatment. It is a passive immunotherapy, acting via the skin and wound microbiome without the use of antimicrobial action. In a general patient population, it removed wound infections 60% and initiated tissue regeneration 50% quicker than antibiotics and antiseptics. As MPPT supports the immune system, the aim was to confirm that MPPT is also effective in immunocompromised individuals. People with spinal cord injury (SCI) are immunodeficient due to their injury and not an underlying disease and recruit 50% fewer immune cells to an injury. The study, therefore, determined the efficacy, safety, health economics, and sustainability of MPPT in acute and chronic wounds and pressure ulcers in this patient population. Pressure ulcers in SCI persons are an orphan indication, patient variability is high, and ICH E10 excludes comparators due to ethical concerns. The study design was, therefore, a single-arm, non-interventional, observational, post-market surveillance study of MPPT for treating wounds and pressure ulcers and removing soft tissue infection in connection with draining fistulas in SCI persons. The study was based on telemedicine in community care. The study included 44 wounds. All acute and chronic grade 1-4 wounds and pressure ulcers reached stable closure. In wounds acting as fistulas draining from an underlying, primary focus of infection, e.g., osteomyelitis, MPPT removed the soft tissue infection in approx. 2.5 months and supported regeneration, considerably reducing fistula sizes. Compared to standard care, per-wound cost savings were 51 to 94% depending on wound grade and age, and substantial nursing resources were freed up. The telemedicine approach was well received by participants and supported independence and self-care. The use of antimicrobials, plastics, and synthetic polymers was essentially eliminated. MPPT did not require bed rest. The study confirmed that MPPT is safe and effective in treating acute and chronic wounds in immunocompetent and immunocompromised individuals, including wounds with antimicrobial-resistant infections. MPPT also removes soft tissue infections caused by an underlying primary focus of infection, such as osteomyelitis. Non-healing wounds currently represent an unmet clinical need. The findings suggest that a therapy acting via the microbiome without antimicrobial actions is effective.

Oral collagen supplementation in 2nd degree burn and chronic pressure ulcers

Oral collagen supplementation in 2nd degree burn and chronic pressure ulcers

Evaluation of the effectiveness of low-level laser therapy on proliferation of fibroblasts isolated from chronic wounds in human in vitro

Chronic wounds pose significant challenges in healthcare due to impaired healing mechanisms. Fibroblast cells play a crucial role in wound healing by orchestrating proliferation and migration. This study aimed to assess fibroblast cells derived from chronic wounds and explore the impact of low-level laser therapy (LLLT) on their growth and migration. Dermal samples from chronic pressure ulcers and diabetic ulcers were obtained from 20 patients at three sites. Fibroblasts from wound base, margins, and adjacent healing skin were isolated and characterized. Proliferation and migration capabilities of these cells were evaluated. LLLT was applied at various energy levels (2.5, 3, 3.5, 4, and 5 J/cm²) to assess its effect on cell count. Fibroblasts from chronic wounds exhibited slower proliferation and migration rates compared to normal dermal fibroblasts. Notably, LLLT intervention at different energy levels led to a significant increase in cell count, with the most pronounced effect observed at 3 J/cm². LLLT at an energy level of 3 J/cm² demonstrated a notable enhancement in fibroblast migration. These findings underscore the potential of LLLT as a therapeutic approach for chronic wounds, offering insights into its efficacy in augmenting fibroblast functions crucial for wound healing.

A Clinical Case Report: Utility of Amniotic Membrane in Treating a Geriatric Diabetic Patient with a Chronic Pressure Ulcer

Chronic wound closure is the inability for a wound to progress through the standard wound healing stages and timeframe, often stalling during the inflammatory stage. This paper presents a two-year open wound endured by a Native American patient of geriatric age and uncontrolled type II diabetes based on elevated A1c levels. Multiple therapeutic modalities had been attempted to close the wound, without improvement. Yet, when a minimally processed human amniotic allograft was applied on a weekly basis, wound closure was demonstrated, based on surface area and volume measurement calculations. This case study shows that weekly applications of human amniotic membrane can impact delayed or stalled wound closure by facilitating healing. Thereby, demonstrating the efficacy of human allografts in difficult to heal chronic wounds, in diabetic patients.

Three-dimensional reconstruction and evaluation of decubitus using a 3d scanner

The aim of this study is to improve the field of patient care in medicine by utilizing information technology, as well as to help, assist nurses and doctors in their work and accelerate patients' recovery. In the case of long-term, mostly elderly patients, a condition known as chronic pressure ulcer, decubitus, or pressure sore may develop. Treating these decubitus ulcers takes time and patience. In order to find the appropriate treatment, it can be helpful to gather as much data as possible about the wound and categorize the severity type based on these collected data. This problem will be addressed and explored using the potential of artificial intelligence and three-dimensional digitisation.

Strategies to Prevent Lower-Extremity Positioning Injuries During Long-Duration Surgery in the Lithotomy Position: Our Techniques and Clinical Outcomes Following Genital Gender-Affirming Surgeries

Purpose: Lower-extremity (LE) injuries due to prolonged surgery duration in the dorsal lithotomy (DL) position are often morbid and can significantly affect the patient’s short and long-term quality of life. These include the development of lower extremity pressure ulcers, neuropathies, rhabdomyolysis, and compartment syndromes. As compared to other surgeries, this risk is increased in patients undergoing genital gender-affirming surgery (gGAS) due to the relatively long operative time of these surgeries related to their high complexity. Our study aimed to describe our technique for preventing LE injuries in the DL position, and to evaluate our positioning-related post-operative complications and rates. Materials and Methods: We describe our technique for positioning in the dorsal lithotomy position, with an emphasis on injury prevention. We ensure a specific padding technique of the LE, we alert surgical assistants to not lean/rest on the LE, and we schedule LE checks and repositioning throughout the case to prevent and mitigate occult injuries. Herein, we report our clinical positioning-related outcomes and complications among all patients undergoing gGAS procedures lasting >300 minutes between January 2017 to March 2023. Results: A total of 227 patients underwent 310 surgical procedures (156 masculinizing, 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes+/-156.5 minutes (SD) (Range 300–1095 minutes). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-op. No (0%) patients had major complications including chronic nerve injury, pressure ulcers, rhabdomyolysis, or compartment syndrome. Conclusions: Our study is the first to describe a replicable technique, and specifically which integrates the OR team and nursing staff, to prevent LE injuries during DL. We show that it is possible to achieve a 0%-to-rare incidence of major LE injury during long-duration surgeries.

Thigh Abscess Formation Due to Severe Sacral Pressure Ulcer Dissemination: A Case Report

Patients with chronic and non-healing pressure ulcers are susceptible to recurrent infections, often leading to complications, such as abscesses. However, to the best of our knowledge, no cases of abscesses disseminating from a pressure sore to the thigh have yet been reported in the literature. We report the case of a 53-year-old man with a severe pressure ulcer in the sacral area and an abscess extending to the thigh. The presence of an abscess in an area devoid of pressure ulcers was suspected. Prior to surgical intervention, a comprehensive evaluation was undertaken, culminating in debridement and subsequent reconstruction, yielding excellent results. Abscesses are often difficult to evaluate with physical examination alone. Therefore, the possibility of extensive abscess formation and dissemination should be considered in patients with severe pressure ulcers.

Systematic review of topical interventions for the management of pain in chronic wounds.

Chronic wounds adversely affect quality of life. Pain is associated with chronic wounds, and its impact can vary according to wound aetiology, condition, and patient factors. This systematic review examined the effectiveness of topical interventions in the management chronic wound-related pain guided by PRISMA recommendations of randomised controlled trials (RCTs) where pain reduction is the primary outcome. Inclusion criteria were adults (older than 18 years) with chronic venous, arterial, diabetic, or pressure ulcers where pain has been managed through topical administration of pharmacological/nonpharmacological agents. Searches were conducted in Ovid Embase, Ovid MEDLINE, EBSCOhost, CINAHL, CENTRAL, PubMed, Web of Science, and Scopus. Studies were screened for eligibility; risk of bias and data were extracted by 2 independent assessors. Searches retrieved 10,327 titles and abstracts (7760 after deduplication). Nine full texts (1323 participants) examining ibuprofen (n = 4), morphine (n = 2), BWD + PHMB [polihexanide-containing biocellulose wound dressing] (n = 1), and EMLA (n = 2) were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was not possible, but initial exploration suggests improved outcomes (reduced pain) for ibuprofen when compared with controls. Two studies involving morphine showed conflicting findings. Included studies often had small samples, and considering confounding factors (eg, comorbidities), the results should be interpreted with caution. Review of included studies suggests that topical interventions may provide pain relief in individuals with chronic wounds. Further adequately powered RCTs are recommended to assess the efficacy of topical interventions for the management of chronic wound-related pain.

Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults.

With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.

Successful Healing of Two Very Large Pelvic-Perineal Chronic Fistulized Ulcers in A Patient with Congenital Myelomeningocele Treated with A Carbohydrate Polymer with Zinc Oxide: Case Report

Importance: A new successful therapeutic option for chronic complicated pressure lesions using a Carbohydrate Polymer with Zinc Oxide (CPZO®). Introduction: A 20-year-old male patient diagnosed with congenital Myelomeningocele was seen and examined in our office on December 08, 2014. When we first received the patient, he had two very large fistulized pressure ulcers stage IV in the gluteal and perianal areas. Both ulcers presented evidence of infection, with purulent fecal discharge, and extensive inflammation and destruction of surrounding tissue. Conclusions and Relevance: This case proves the therapeutic efficiency of CPZO® a new Medical Device II with pro- healing, anti-inflammatory and bactericidal properties on a young male patient with chronic complicated severe pressure ulcers.

Hronične dekubitalne rane kod traumatskih i netraumatskih pacijenata u jedinicama intenzivnog lečenja

Introduction/Aim: Patients, who stay long in hospitals, nursing homes, and especially in intensive care units, are exposed to the risk of developing chronic wounds. The term "chronic wound" refers to wounds that do not heal despite all treatment measures taken in the period of six to eight weeks. The aim of this retrospective cohort study was to analyze data on chronic pressure ulcers that were collected in intensive care units (ICU) of the Urgent Care Center of the Clinical Center of Serbia during the five-year period, with the aim of determining the factors that influence their occurrence and healing. Methods: The retrospective cohort study was conducted from January 1st, 2018 to April 1st, 2023 at the Urgent Care Center of the University Clinical Center of Serbia in the intensive care units in polytrauma, neurosurgical and surgical patients. The study included 74 patients diagnosed with chronic pressure ulcers. Data for all participants were obtained from medical history and list of discharge. Results: During in-hospital treatment in ICU, pressure ulcers were found in all 74 patients (56.8% of women and 43.2% of men), while combined chronic wounds were found in 57 (77.0%) patients. The largest number of these patients were elderly (70 and older) (31.1%) and with non-traumatic injuries (62%). All patients were tracheotomized with a gastrostomy tube placed. The localization of pressure ulcers was most often in the lumbosacral region (44.6%), followed by the trochanteric region (23.0%). The majority of patients had hypertension (90.5%), diabetes (79.7%) and chronic obstructive pulmonary disease (82.4%), while 28 patients (37.8%) died. 38 patients were underweighted (51.4%), while 11 (14.9%) patients were overweight and obese. Conclusion: Risk factors for the occurrence of pressure ulcers should be evaluated at the moment of the first contact of the doctor with the immobile patient because this is the only prerequisite for timely prevention. Special emphasis should be placed on the elderly, underweight and people with comorbidities.

Chronic Pressure Ulcer Treatment Using a Combination of Stromal Vascular Fraction and Split-Thickness Skin Grafting.

Chronic Pressure Ulcer Treatment Using a Combination of Stromal Vascular Fraction and Split-Thickness Skin Grafting.

Malignant Transformation in Chronic Stage IV Sacral Pressure Ulcer: A Case of Marjolin Ulcer

A Marjolin ulcer (MU) is a rare type of skin cancer that most commonly occurs in burns and other traumatic scars, and it also may arise in chronic, poorly healing wounds. Typically, MU presents as a squamous cell carcinoma and has a high rate of metastasis resulting in poor prognosis. The mechanism of the aggressive and metastatic potential of MU has not been clearly defined. This malignancy is more common in patients who are elderly or immunocompromised and has also been characterized as a disease of economically developing nations in which health care resources are less abundant and treatment is delayed. Marjolin ulcer is a challenging, although rare, disease. This article presents a case of MU that arose in a chronic sacral pressure ulcer. This was a rare, multifactorial case; the patient's many comorbidities required coordinated efforts by wound care, oncology, and infectious disease specialists. As seen in this case, MU can be insidious and may not become apparent until considerable progression has occurred. This article discusses the multidisciplinary treatment measures undertaken for this patient, the strategies for prophylaxis and early detection of MU, and ultimately, the poor prognosis of MU in such a scenario where diagnosis is delayed.

Development of a model to predict closure of chronic wounds in Germany: Claims data analysis.

Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time‐to‐event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c‐statistics. This requires future data linkage between SHI and primary studies (eg, registers).

Half man, half prosthesis: the rehabilitation of people with hemicorporectomy – case series

Hemicorporectomy is a procedure where the lumbar spine and spinal cord, pelvic bones and contents, lower extremities and external genitalia are surgically removed. The rehabilitation process, in addition to being prolonged and costly, is challenging. This article reports the rehabilitation process for hemicorporectomy and shows the innovative solutions for mobility for this disability for two cases of paraplegic patients: case 1 due to traumatic spinal cord injury due to firearm injury and case 2 due to lumbosacral myelomeningocele. They presented chronic pressure ulcer which evolved to neoplastic transformation. (squamous cell carcinoma - Marjolin's ulcer). The cases were submitted to L4 hemicorporectomy and were rehabilitated to ensure the right to mobility independence for activities of daily living; social inclusion; prevention of comorbidities and pluralization of disabilities. The rehabilitation involved the elaboration of a new prosthesis for the hemibody and improvement of functional capacity, within a gain of 6 - 11 points in the Functional Independence Measure (FIM). The principal changes happened in social interaction, locomotion and transfers to a bed/chair and toilet. Despite the body transformation, patients show gains in quality of life mainly for the social domain of World Health Organization Quality of Life instrument-brief version (WHOQOL-bref). In general, there is an increase in the scores of this instrument from 1.78% -19.25%. The evolution of social inclusion through the International Classification of Functioning, Disability and Health (ICF) reveals that patients are able to resume social, working, academic-professional life and recreation and leisure activities, reducing the number of severe and complete qualifiers from 90.91 to 60% when using the products appropriate assistive devices. Hemicorporectomy can be a therapeutic option for those in need, as it provides functionality without the need for caregivers and resumes educational, professional, economic and social aspects with gains in quality of life.