Multiple Pressure Sores Research Articles

Surgical treatment and strategy in patients with multiple pressure sores.

Pressure sores remain a common health problem, particularly among the physically limited or bedridden elderly, and can cause significant morbidity and mortality. This study aimed to present our surgical treatment and strategy for patients with multiple pressure sores. Between January 2010 and December 2016, 18 patients were enrolled. After adequate debridement, pressure sores were managed based on our treatment protocol. Patients' age, aetiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. A total of 10 men and 8 women (average age, 82.3 years) with a mean follow-up period of 28.3 months (6-72 months) were included. The mean defect area was 63.7 cm2 . The most common aetiology of the bedridden state was cerebrovascular accident (38.89%), and the most frequent sores were trochanteric pressure sores (53.57%). The average operative time and blood loss were 105.5 minutes and 100.8 mL, respectively. No haemodynamic variation or blood transfusion was noted during the surgery. The complication rate for each sore was 10.7%, including late recurrence. In conclusion, treating pressure ulcers requires careful patient education, intensive multidisciplinary optimisation, and meticulous wound care, and our treatment protocol ensures a shorter surgery time, less bleeding, and low complication rate.

Role of Low Level Laser Therapy (LLLT) in Pressure Sore Management

There are situations when patients are unfit for anesthesia or unwilling for surgery when plastic surgeon has to make the wound heal by secondary intention.In such situations adjunct therapies like Low Level Laser (LLL) helps in promoting wound healing. LLL are lasers with a wave-length between 600 and 1000 nanometers and power from 5 to 500 Mw. The bio-stimulatory properties of LLL has been found to accelerate wound healing, tissue repair and regeneration. This study highlights the application of LLL in a 40-year-old male with multiple pressure sores unfit foranesthesia.

Cost analysis of surgically treated pressure sores stage III and IV

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures.

Use of Inferior Gluteal Artery and Posterior Thigh Perforators in Management of Ischial Pressure Sores With Limited Donor Sites for Flap Coverage

Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites. Between September 2005 and 2009, 11 patients (9 male, 2 female) with ischial sores were operated by using IGA and posterior thigh perforator flaps. The data of patients included age, sex, cause of paraplegia, flap size, perforator of flap, previous surgeries, recurrences, complications, and postoperative follow-up. Nine IGA and 5 posterior thigh perforator flaps were used. Six patients presented with recurrent lesions, 5 patients were operated for sacral and contralateral ischial pressure sores previously. In 2 patients, IGA and posterior thigh perforator flaps were used in combination. Patients were followed for an average of 34.3 months. In 2 recurrent cases, readvancement of IGA perforator flap and gluteus maximus myocutaneous flap were treatment of choice. Treatment of patients with recurrent lesions or multiple pressure sores is challenging because of limited available flap donor sites. In this study, posterior thigh perforator flaps were preferred in patients in whom the previous donor site was the gluteal region. IGA perforator flaps were the treatment of choice in patients for whom posterior thigh region was previously used. Alternately, preserved perforators of previous conventional myocutaneous flaps enabled us to use these perforators in recurrences.

A single fatal dose of olanzapine

Sir, A 52-year male presented with acute onset clouding of consciousness, rigidity, diaphoresis, urinary incontinence, and myoclonic jerks. He had recently developed a stress induced mood disturbance for which he was prescribed olanzapine. He had consumed a single 5 mg dose of the drug on the previous morning. Two hours post admission he developed high rise of temperature with further deterioration of sensorium. Neurological examination revealed a Glasgow coma scale score of 6, ‘lead-pipe’ rigidity, generalized myoclonus, and brisk deep tendon reflexes. The serum creatinine phosphokinase (CPK) level was 8,240 U/L, (Normal 60-400 U/L) and urine was positive for myoglobin. We diagnosed the case as neuroleptic malignant syndrome, discontinued olanzapine and initiated bromocriptine and clonazepam. His serum iron level was 18mg/dl. Serial CPK estimation showed a gradual normalization over the next eight days but there was little improvement in his sensorium even one month after CPK normalization. Prolonged recumbence resulted in multiple pressure sores and he eventually succumbed to aspiration pneumonia eight weeks after his admission.

非クロストリジウム性ガス壊疽を伴った多発性褥瘡の 1 例

非クロストリジウム性ガス壊疽を伴った多発性褥瘡の 1 例

Clostridium ramosum Bacteremia and Osteomyelitis in a Patient with Infected Pressure Sores

Clostridium ramosum is one of the anaerobes commonly implicated in soft tissue and intra-abdominal infections. Invasive systemic infections and bacteremias are rare, however, because C. ramosum is less virulent compared with C. perfringens and other clostridia [1]. We report a case of osteomyelitis and bacteremia caused by C. ramosum in a patient with multiple pressure sores. Case Report. A 91-year-old nursing home resident, with hypertension and diabetes, was referred for evaluation of fever. Initial assessment revealed a demented, bedridden patient who appeared toxic, with a temperature of 102°F. She had multiple pressure sores, including stage IV ulcers over the left hip (9 × 7 cm) and sacrum (9.5 × 8 cm) and a stage III ulcer over the right hip (4 × 3.5 cm). The ulcer over the hip extended to the bone and had a foul-smelling purulent discharge and necrotic debris at the base. Further examination was unremarkable except for scattered rales and a short aortic ejection systolic murmur. Laboratory results showed leukocytosis (18.9) with a left shift and anemia (hematocrit 22.7). Urinalysis was normal, and a chest roentgenogram did not reveal any infiltrates. Blood cultures were drawn, and the patient began receiving ampicillin-sulbactam and gentamicin. The two sets of blood cultures performed at different time intervals, from different sites, both yieldedC. ramosum.Blood cultures were incubated in the BACTEC 9240 system (Becton Dickinson, Sparks, MD) and subcultured on a blood agar plate and CDC’s blood agar plate media with a gas pack pouch anaerobic system (BBL Becton Dickinson Microbiology systems, Cockeysville, MD). The identity of the organism was established with the API 20 A anaerobic strip (bioMerieux, Hazelwood, MO). A computed tomographic scan of the abdomen and pelvis, although negative for abdominal pathology, revealed a large ulcer over the left hip, intramedullary gas in the femoral head, and a small pocket of fluid anterior to the hip consistent with osteomyelitis. Gas was also seen in the soft tissue surrounding the ulcer. Antibiotics were continued and surgical debridement was done. The patient received a packed red blood cell transfusion for anemia, and blood sugars were controlled with multiple daily doses of regular insulin. A transthoracic echocardiogram showed mild aortic stenosis but did not reveal any evidence of vegetations. The patient responded well to treatment and was afebrile by the third day. Subsequent blood cultures were negative forC. ramosum.Two weeks later, the patient remained afebrile, the pressure sores appeared to be healing, and she was discharged to the nursing home on antibiotics. Discussion. C. ramosum is an anaerobic, spore-forming, non-motile, thin, gram-positive rod, which occurs singly, in pairs, or in short chains. It was first isolated by Veillon and Zuber in 1898 [2]. Holdeman et al. [3] found that it was a spore-forming anaerobe and placed it in the genus Clostridia. It is indigenous to the human intestinal tract and has been isolated from human feces [1]. C. ramosum has frequently been implicated in wound infections after intraabdominal trauma, acute bowel perforation, and colorectal abscesses [4,5]. However, it has seldom been isolated from pressure sores [6]. Infected pressure sores can cause metastatic or contiguous osteomyelitis. Anaerobic osteomyelitis is increasingly recognized in this setting, but clostridia have not often been implicated [7]. In our patient, bacteremia probably resulted from the severely infected pressure sores. Evidence of infection with a gas-forming organism in soft tissues around the hip and isolation of C. ramosum from two separate sets of blood cultures lend credence to our assumption. The incidence of clinically significant clostridial bacteremias has been increasing, and isolated cases of unusual clostridial bacteremias have been reported in patients with pressure sores [8]. C. ramosum bacteremia has been reported in a patient with acute bowel perforation and in a renal allograft recipient with mural endocarditis [5,9]. Our report demonstrates C. ramosum as a pathogen causing soft tissue infection, osteomyelitis, and bacteremia in the setting of pressure sores. C. ramosum is often resistant to penicillin and shows varying susceptibility to clindamycin and cephalosporins. This can potentially result in therapeutic failure [10]. Infected pressure sores should be recognized as a source of deep-seated clostridial infections, including bacteremia and osteomyelitis. We also emphasize the importance of species identification, if not antibiotic susceptibility testing, in clostridial infections.

Psychological factors in the causation of pressure sores: case report

A high incidence of re-admissions to a spinal injuries unit by a small number of patients suffering from multiple pressure sores is described. The study shows an increased association of skin fragility and poor healing with an altered psychological behaviour. This combination of vulnerability to recurrent pressure sores in association with the pathological intellectual debility is described as 'ectodermic syndrome'. This restricts the eventual rehabilitative outcome.

Thyrotoxicosis Induced by Topical Iodine Application

We describe an elderly man who was admitted with congestive cardiac failure and found to have thyrotoxicosis. He did not have goiter, and he had normal radioiodine uptake in his neck. Serum iodine levels were elevated, explaining the lack of increase in radioiodine uptake in the thyroid gland. He had multiple pressure sores, which were treated with povidone-iodine (Betadine) soaks. Biochemical data were consistent with Graves' disease unmasked by topical iodine application. Povidone-iodine soaks are commonly used in decubitus ulcer care and warrant special attention in patients with preexisting thyroid disorders. We have reviewed the literature on this unusual complication.

Thyrotoxicosis induced by topical iodine application

• We describe an elderly man who was admitted with congestive cardiac failure and found to have thyrotoxicosis. He did not have goiter, and he had normal radioiodine uptake in his neck. Serum iodine levels were elevated, explaining the lack of increase in radioiodine uptake in the thyroid gland. He had multiple pressure sores, which were treated with povidone-iodine (Betadine) soaks. Biochemical data were consistent with Graves' disease unmasked by topical iodine application. Povidone-iodine soaks are commonly used in decubitus ulcer care and warrant special attention in patients with preexisting thyroid disorders. We have reviewed the literature on this unusual complication. (<i>Arch Intern Med.</i>1990;150:2400-2401)

Rehabilitation of a patient severely involved with multiple sclerosis.

This case study presents a young woman who was admitted to our facility in an emaciated physical condition. She had multiple pressure sores and severe contractures about the neck, trunk, and lower extremities, necessitating dependence in all care. Slow but consistent progress was noted trhoughout a four-month aggressive rehabilitation program. The various treatment approaches and resulting functional gains are detailed.