Pressure Injuries In Patients Research Articles

Investigation on the alleviating effect of standardized three-step nursing on perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury

Objective To explore the alleviating effect of standardized three-step nursing on perioperative pressure injury in patients with spinal fractures accompanied by spinal cord injury. Methods A retrospective analysis was conducted on the clinical data of 153 patients who underwent surgical treatment for spinal fracture accompanied by spinal cord injury in our hospital from January 2021 to January 2024. All patients met the criteria for inclusion and exclusion. According to the nursing interventions received during the perioperative period, the patients were divided into a control group (n = 76) and an observation group (n = 77). The control group received routine nursing interventions during the perioperative period, while the observation group received standardized three-step nursing interventions. The occurrence, severity, area, and pain [Visual Analog Scale (VAS)], coagulation indicators [prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], activities of daily living [Barthel Index], and quality of life [General Quality of Life Inventory (GQOLI-74)] were compared between the two groups. Results (1) Occurrence and severity of perioperative pressure injury: in the control group, 18 cases of pressure injury occurred, including 5 cases of stage I, 11 cases of stage II, and 2 cases of stage III; in the observation group, 7 cases of pressure injury occurred, including 4 cases of stage I and 3 cases of stage II. The occurrence rate and severity of pressure injury in the observation group were lower than those in the control group (p < 0.05). (2) Area of injury and pain: The area of injury on the day of surgery and 5 days after surgery in the observation group was lower than that in the control group (p < 0.05); the VAS score 5 days after surgery in the observation group was lower than that in the control group (p < 0.05). (3) Coagulation indicators: 5 days after surgery, the levels of D-D and FIB in the observation group were lower than those in the control group, while PT was higher than that in the control group (p < 0.05). (4) Activities of daily living and quality of life: 3 months after surgery, the Barthel score and GQOLI-74 score in the observation group were higher than those in the control group (p < 0.05). Conclusion Standardized three-step nursing can significantly reduce the occurrence rate, severity, and area of perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury, alleviate patient pain, improve coagulation function, and enhance levels of activities of daily living and quality of life.

Prediction model of pressure injury occurrence in diabetic patients during ICU hospitalization——XGBoost machine learning model can be interpreted based on SHAP

BackgroundThe occurrence of pressure injury in patients with diabetes during ICU hospitalization can result in severe complications, including infections and non-healing wounds. AimsThe aim of this study was to predict the occurrence of pressure injury in ICU patients with diabetes using machine learning models. Study designIn this study, LASSO regression was used for feature screening, XGBoost was employed for machine learning model construction, ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score were used for evaluating the model's performance. ResultsOut of the 503 ICU patients with diabetes included in the study, pressure injury developed in 170 cases, resulting in an incidence rate of 33.8 %. The XGBoost model had a higher AUC for predicting pressure injury in patients with diabetes during ICU hospitalization (train: 0.896, 95 %CI: 0.863 to 0.929; test: 0.835, 95 % CI: 0.761–0.908). The importance of SHAP variables in the model from high to low was: 'Days in ICU', 'Mechanical Ventilation', 'Neutrophil Count', 'Consciousness', 'Glucose', and 'Warming Blanket'. ConclusionThe XGBoost machine learning model we constructed has shown high performance in predicting the occurrence of pressure injury in ICU patients with diabetes. Additionally, the SHAP method enables the interpretation of the results provided by the machine learning model. Relevance to clinical practiceImprove the ability to predict the early occurrence of pressure injury in diabetic patients in the ICU. This will enable clinicians to intervene early and reduce the occurrence of complications.

Risk Factors of Intraoperative Pressure Injury in Adult Patients Undergoing Neurologic Surgery.

To present research investigating the incidence of and risk factors associated with intraoperative pressure injury in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Identify the incidence of intraoperative pressure injuries (PIs) in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China.2. Describe risk factors for intraoperative PI.3. Outline strategies to help mitigate intraoperative PI risk.

Braden score can independently predict 90-day mortality in critically ill patients with dementia.

Dementia is a significant cause of death in the older population and is becoming an important public health issue as the population ages and the prevalence of dementia increases. The Braden score is one of the most commonly used clinical tools to assess the risk of skin pressure injury in patients, and some studies have reported that it may reflect the state of frailty of patients. The present study attempted to explore the association between Braden score and 90-day mortality, pressure injury, and aspiration pneumonia in older patients with dementia in the intensive care unit (ICU). The study involved extracting crucial data from the Medical Information Market for Intensive Care IV (MIMIC-IV) database using Structured Query Language, with a license certificate obtained after completing the necessary training and examination available on the MIMIC-IV website. A retrospective analysis was performed on older patients with dementia, aged 65 or older, who were first admitted to the ICU. Ninth and tenth revision International Classification of Diseases codes were used to identify patients with dementia. The primary outcome was 90-day mortality. Cox proportional hazards models were used to determine the association between Braden score and death, and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Propensity score matching and E-value assessments were employed for sensitivity analysis. A total of 2892 patients with a median age of approximately 85years (interquartile range 78.74-89.59) were included, of whom 1625 were female (56.2%). Patients had a median Braden score of 14 (interquartile range 12-15) at ICU admission. Braden score at ICU admission was inversely associated with 90-day mortality risk after adjustment for demographics, severity of illness, treatment and medications, delirium, and sepsis (adjusted HR: 0.92, 95% CI: 0.87-0.98, p=0.006). Patients were divided into two groups with a cut-off value of 15: high-risk group and low-risk group. Compared to the low-risk group (Braden score >15), the risk of 90-day mortality was significantly increased in the high-risk group (Braden score ≤15) (adjusted HR: 1.52, 95% CI: 1.10-2.09, p=0.011, E-value: 2.01), the risk of pressure injury (adjusted OR: 2.62, 95% CI: 2.02-3.43, E-value: 2.62) and aspiration pneumonia (adjusted OR: 2.55, 95% CI: 1.84-3.61, E-value: 2.57) was also significantly higher. The Braden score may be a quick and simple screening tool to identify the risk of adverse outcomes in critically ill older adults with dementia.

Hematologic and Serum Biochemical Values Associated With Different Stages of Hospital-Acquired Pressure Injuries in Patients: A Retrospective Study.

The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients. A retrospective review of medical records. Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020. We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence. Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence. Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs.

Study on the relationship between sublingual microcirculation disorder and pressure injury in patients with acute infection.

Study on the relationship between sublingual microcirculation disorder and pressure injury in patients with acute infection.

Oral pressure injuries in patients hospitalized during the COVID-19 pandemic and associated factors: a cross-sectional study

Background: Patients critically ill with coronavirus disease (COVID) who are admitted to intensive care unit (ICU) are susceptible to a vast number of complications that life-threatening. Objective: To investigate the frequency of oral cavity pressure injuries (OPI) in adult patients hospitalized for COVID in an ICU and associated factors. Method: A retrospective cross-sectional study was carried out using electronic medical records of patients admitted to the ICU, whether due to COVID or other conditions (NO COVID), in São Luís, Maranhão, Brazil. Demographic data, comorbidities, length of stay, intubation time, O2 saturation, use of vasoactive drugs, and hospitalization (due to COVID or NO COVID), and OPI were extracted from the medical records. The data was subjected to descriptive statistics, Chi-square test, Mann-Whitney test and Poisson regression (α=5%). Results: The frequency of OPI in patients hospitalized for COVID was 38.5%. The most frequent comorbidities in both groups were hypertension and diabetes mellitus. The use of vasoactive drugs and OPI was more frequent in the NO COVID group (p=0.010; p=0.021). The average length of stay was significantly longer for the COVID group (15.8 days) compared to the NO COVID group (10.6 days) (p=0.025). The average length of hospitalization and intubation was significantly higher for the group with OPI (p=0.003; p&lt;0.001). In the adjusted regression analysis, the length of intubation was the factor suggestive of explaining to OPI (PR=2.547; CI=1.423-4.558). Conclusion: Longer hospitalization and intubation times were responsible for pressure injuries in the oral cavity, demonstrating the need for continuous assessment of hospitalized patients in order to prevent the establishment of these injuries.

Pressure injury risk factors in patients undergoing general anesthesia surgeries.

Pressure injuries result from prolonged pressure and lead to tissue damage, infections, extended recovery times, and an economic burden. To explore risk factors for pressure injuries in patients who underwent surgery under general anesthesia. This retrospective study included patients who underwent surgery at a regional educational hospital in southern Taiwan from January 1, 2018, through December 31, 2018. A comprehensive multivariate analysis was used to identify the prominent risk factors for pressure injury among the 11 231 patients enrolled in this study. These risk factors were an age of ≥65 years; surgery duration of >120 minutes; diastolic blood pressure of <60 mm Hg for >30 minutes during surgery; intraoperative use of dopamine, norepinephrine, or epinephrine as vasopressors; American Society of Anesthesiologists physical classification of III or higher; minimum intraoperative body temperature of ≤35°C; blood loss of >500 mL; and a supine or prone surgical position. This study identified several pressure injury risk factors related to surgical conditions and patient characteristics. Surgical teams must monitor, control, and manage these factors, prioritize staff education, and adopt preventive protocols.

Prediction Model for Postoperative Pressure Injury in Patients with Acute Type A Aortic Dissection.

To establish a risk assessment model to predict postoperative National Pressure Injury Advisory Panel stage 2 or higher pressure injury (PI) risk in patients undergoing acute type A aortic dissection surgery. This retrospective assessment included consecutive patients undergoing acute type A aortic dissection surgery in the authors' hospital from September 2017 to June 2021. The authors used LASSO (logistic least absolute shrinkage and selection operator) regression analysis to identify the most relevant variables associated with PI by running cyclic coordinate descent with 10-times cross-validation. The variables selected by LASSO regression analysis were subjected to multivariate logistic analysis. A calibration plot, receiver operating characteristic curve, and decision curve analysis were used to validate the model. There were 469 patients in the study, including 94 (27.5%) with postoperative PI. Ten variables were selected from LASSO regression: body mass index, diabetes, Marfan syndrome, stroke, preoperative skin moisture, hemoglobin, albumin, serum creatinine, platelet, and d-dimer. Four risk factors emerged after multivariate logistic regression: Marfan syndrome, preoperative skin moisture, albumin, and serum creatinine. The area under the receiver operating characteristic curve of the model was 0.765. The calibration plot and the decision curve analysis both suggested that the model was suitable for predicting postoperative PI. This study built an efficient predictive model that could help identify high-risk patients.

Risco de lesão por pressão em pacientes submetidos à cirurgia de coluna

Objective: To verify the risk of pressure injury in patients undergoing spine surgery and analyze the associated risk factors. Method: This is a descriptive-exploratory, cross-sectional field research, with quantitative analysis carried out in two stages (pre-operative and intraoperative), with 55 patients undergoing spine surgery, in a private hospital in São Paulo, Brazil, through the application of a characterization form of the participant and the surgery and the application of the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO). Results: According to ELPO, 33 of the 55 patients (60.0%) had a higher risk score for pressure injury. Patients at highest risk had an average age of 50.2 years, classified as overweight and obese, and had a mean surgery time of 2 hours and 45 minutes. There were significant statistical differences between the higher and lower risk groups, related to: age, weight, body mass index, and surgery time. The patient’s risk of developing a pressure injury increases proportionally with increasing age, weight, body mass index, and surgery duration. As these factors increase, the patient’s risk of developing pressure injury increases. Conclusions: The risk of pressure injury related to spinal surgical procedures was significant, evidencing a reality in which the perioperative nurse is responsible for planning preventive measures to mitigate the occurrences of such injuries and ensure patient safety.

Prevalence of pressure injury in patients on enteral nutritional therapy with COVID-19

Prevalence of pressure injury in patients on enteral nutritional therapy with COVID-19

Feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation

ObjectivesDescribe the feasibility, acceptability, and usability of implementing a nurse-led intervention to prevent medical device-related pressure injury in critical care patients using non-invasive ventilation during hospitalization. Study designA quality improvement project, using a descriptive single-arm study design with convenience sampling. Setting and participantsThis study was conducted at a Midwestern medical center with 640 beds (two hospital campuses). After an educational session, the nurse-led algorithm for non-invasive ventilation medical device-related pressure injury prevention was implemented in two critical care nursing units (cardiac medical progressive care and neurotrauma intensive care unit). Nursing staff were full or part-time critical care nurses. Main outcome measuresFeasibility, acceptability, and usability of the non-invasive ventilation medical device-related pressure injury algorithm were measured (bedside rounding and pre/post System Usability Scale). ResultsThirty-five nurses (52.2 %) completed a pre-educational survey; 8 (11.2 %) completed a post-survey. The total mean pre-survey score was 70.7 (SD ± 13.6) and the post-survey mean score was 71.3(SD ± 19.6). There was a statistically significant increase in the post-survey mean score {Χ2 (1, N = 43) = 43.5, p <.05}, however, the 0.06 increase was not clinically meaningful. Bedside rounding interviews (n = 22) indicated 82 % (n = 18) of the nurses used the algorithm. The SUS tool mean score was 83.3 (10.73) pre-implementation (n = 21); and 85.63 (8.26) post-implementation (n = 5), indicating clinical usability of the algorithm pre- and post-implementation. ConclusionThe feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation were demonstrated during this study. More nursing research is needed to develop scalable interdisciplinary clinical algorithms to reduce medical device-related pressure injuries in patients using non-invasive ventilation. Implications for clinical practiceThis study focused on the bedside usability of the algorithm in a clinical setting. Implementing this nursing-developed algorithm created an interdisciplinary framework in which nursing assessment may guide clinical care.

Implementation of a Pressure Injury Prevention Protocol for Intensive Care Unit Patients Undergoing Prone Positioning.

Pressure injuries remain the most common hospital-acquired condition, according to the Agency for Healthcare Research and Quality. Patients hospitalized with COVID-19 are at especially high risk for pressure injuries, including those related to medical devices, because of their lower tissue tolerance, prolonged intubation, and common treatment with prone positioning. The COVID-19 pandemic brought an increased incidence of hospital-acquired pressure injury. A 350-bed hospital in St. Joseph, Missouri, recognized that an intervention to lower the risk of pressure injury for these patients was needed. A quality improvement project was initiated to reduce the incidence of pressure injuries in patients with COVID-19 in the intensive care unit. A protocol was implemented for patients with COVID-19 undergoing prone positioning that included the use of dressing packets. The incidence of hospital-acquired pressure injury during the 1-year periods before and after implementation of the protocol were determined. Before implementation of the new protocol, 18 of 155 intensive care unit patients with COVID-19 who were placed in a prone position (11.6%) experienced a hospital-acquired pressure or medical device-related injury, compared with 3 of 111 patients (2.7%) after protocol implementation, a reduction of 76.7% (P = .008). The risk of hospital-acquired pressure injuries can be reduced with additional education and the use of appropriate products and protocols. All patients who undergo prone positioning, regardless of diagnosis, may benefit from implementation of a pressure injury prevention protocol that includes the use of dressing packets.

Repositioning for pressure injury prevention in adults: a commentary on a Cochrane review.

Repositioning is regarded as an important intervention to prevent the development of pressure injuries in patients who are immobile. However, there is uncertainty as to the optimal regimen in terms of frequency and method of repositioning. This commentary summarises and critically appraises a Cochrane systematic review that assessed the clinical and costeffectiveness of different repositioning regimens on the prevention of pressure injuries in adults in any setting.

INTERVENTIONS IN THE FACE OF PRESSURE INJURY PREVENTION IN PATIENTS HOSPITALIZED IN INTENSIVE CARE UNITS (ICU)

Identify and understand nursing interventions in the face of pressure injury prevention in patients hospitalized in Intensive Care Units (ICU). Identifying extrinsic/intrinsic factors, scientific knowledge about risk factors, classification, diagnosis and nursing care in the face of pressure injury prevention in patients hospitalized in the Intensive Care Unit (ICU). Identify the nursing interventions in the face of pressure injury prevention in hospitalized patients. Descriptive study of the integrative review type of the literature. Research source: LILACS, BENF, MEDLINE. After applying the inclusion and exclusion criteria, the study sample consisted of 18 articles, filtered between the years of 2017 to 2022, where these studies address the intervention of nursing in the prevention of pressure injury in patients hospitalized in the Intensive Care Unit (ICU). This article showed that nursing interventions are of fundamental importance, and it should be emphasized the constant need to seek technical-scientific knowledge about pressure injury and consequent preparation and execution of treatment plan in order to contribute to the prevention of the emergence of LPP in hospitalized patients in ICU, thus promoting shorter hospital stay and better quality of life in the face of reduced complications resulting from the emergence of a LPP.

Application of modified cotton pads in preventing facial pressure injury in patients with noninvasive mechanical ventilation

Application of modified cotton pads in preventing facial pressure injury in patients with noninvasive mechanical ventilation

Application of self-made anti-pressure sore cotton cover in preventing facial pressure injury in patients with non-invasive ventilation

To observe the application effect of self-made anti-pressure sore cotton cover on the prevention of facial pressure injury in patients with non-invasive ventilation, and to explore the effective method of preventing facial pressure injury. A prospective study was conducted. Patients with mild to moderate respiratory failure and non-invasive ventilation admitted to the department of intensive care medicine of Harisen International Peace Hospital Affiliated to Hebei Medical University from March 2020 to August 2021 were enrolled, and they were divided into gauze pad group, foam dressing group and self-made anti-pressure ulcer cotton cover group by random number table method. Before wearing the ventilator mask, the gauze pad group and the foam auxiliary dressing group should fold or cut out the auxiliary dressing with the corresponding size and suitable for the patient's facial contour. In the self-made anti-pressure sore cotton cover group, the ventilator cotton cover could be worn only by selecting the cotton cover suitable for the patient's face shape, aligning the vent to the mouth and nose, and tying the fixed belt behind the ear. The incidence of facial pressure sore, the time required to connect man-machine interface (from the preparation of auxiliary dressing for pressure sores to the connection of ventilator) and the cost of dressing were compared among the three groups. A total of 150 patients with non-invasive ventilation were enrolled, with 50 patients in each group. Compared with the gauze pad group and the foam dressing group, the incidence of facial pressure sore in the self-made anti-pressure sore cotton cover group was significantly reduced [6.0% (3/50) vs. 44.0% (22/50), 12.0% (6/50), both P < 0.05], and the time required to connect the man-machine interface was significantly shortened (minutes: 5.0±1.5 vs. 10.0±1.5, 8.0±2.0, both P < 0.05), dressing cost was significantly reduced (yuan: 30±10 vs. 150±20, 118±29, both P < 0.05). Compared with the gauze pad and the foam dressing, the incidence of facial pressure sore in non-invasive ventilation patients with self-made anti-pressure sore cotton cover is lower, the time required to connect man-machine interface is shorter, and the cost of pressure sore prevention dressing is less, which is suitable for the prevention of facial pressure injury in non-invasive ventilation patients.

Risk constellation of hospital acquired pressure injuries in patients with a spinal cord injury/ disorder - focus on time since spinal cord injury/ disorder and patients' age.

Prospective cohort study. The aim of this study was to evaluate how time since spinal cord injury/disorder (SCI/D) and patients' age influence risk constellation for hospital acquired pressure injuries (HAPI) in patients with a SCI/D. Acute care and rehabilitation clinic specialized in SCI/D. We collected patients' characteristics and 85 risk factors for HAPI development in adults with SCI/D with at least one HAPI during their inpatient stay between August 2018 and December 2019. We analyzed patients' characteristics and HAPI risk factors using descriptive statistics according to time since SCI/D ( < 1 year, 1-15 years, > 15 years) and patients' age (18-35 years, 35-65 years, > 65 years). We identified 182 HAPI in 96 patients. Comparing patients with SCI/D < 1 year with the other groups, autonomic dysreflexia (p < 0.001), abnormal body temperature (p = 0.001), hypertensive episode (p = 0.005), and pneumonia (p < 0.001) occurred more frequently; mean hemoglobin (p < 0.001), albumin (p = 0.002) and vitamin D levels (p = 0.013) were significantly lower, and patients with time since SCI/D < 1 year scored fewer points (10-12) on the Braden Scale (p < 0.001). Comparing groups per patients' age, only the SCIPUS score was higher in patients > 65 years compared to the other two groups (p = 0.002). Different risk factor constellation seem to be underlying HAPI development with more differences in patients time since SCI/D than patients' age. Awareness of these differences in risk factor constellation depending on time since SCI/D in these patients might lead to different HAPI prevention strategies. The study team didn't receive any additional sponsorship.

Incidence and risk factors for pressure injury in hospitalized non-small cell lung cancer patients: A retrospective observational study

AimThis study aimed to identify the incidence and risk factors for pressure injury in patients hospitalized for non-small cell lung cancer (NSCLC). MethodsThis retrospective observational study was conducted in 645 adults who were hospitalized for NSCLC. Clinicopathological characteristics were compared between NSCLC patients with pressure injury and those without pressure injury. ResultsAmong total 645 patients, 180 patients showed pressure injury with an incidence of 27.9%. Patients with pressure injury showed increased serum C-reactive protein (CRP) levels (P < 0.001), increased neutrophil-lymphocyte ratio (P = 0.002), and increased platelet-lymphocyte ratio (P = 0.001) more often. Increase in serum CRP levels at the time of admission was the major risk factor for development of pressure injury in NSCLC patients (OR = 2.20; 95% CI [1.40–3.45]; P = 0.001). Also, among major inflammatory markers, serum CRP levels at the time of admission showed weak negative correlation with the period from admission to the development of pressure injury (r = −0.216, P = 0.004). ConclusionBy checking serum CRP levels at the time of admission, the NSCLC patients at high risk for the development of pressure injury can be identified in advance and the occurrence of pressure injury can be reduced by applying more active preventive nursing care. Clinical trial registration numberKCT0006570.

Minor microbial alterations after faecal diversion do not affect the healing process of anus-near pressure injuries in patients with spinal cord injury-results of a matched case-control study.

Retrospective matched case-control study including patients with spinal cord injury who presented with an anus-near pressure injury. Two groups were formed based on the presence of a diverting stoma. To evaluate the primary microbial colonisation and secondary infection of anus-near pressure injuries depending on the presence of a pre-existing diverting stoma and to investigate the effect on the wound healing. University hospital with a spinal cord injury unit. A total of 120 patients who had undergone surgery of an anus-near decubitus stage 3 or 4 were included in a matched-pair cohort study. Matching was realised according to age, gender, body mass index and general condition. The most common species in both groups was Staphylococcus spp.(45.0%). The only significantly different primary colonisation affected Escherichia coli, that was found in the stoma patients less often (18.3 and 43.3%, p < 0.01). A secondary microbial colonisation occurred in 15.8% and was equally distributed, except for Enterococcus spp. that was present in the stoma group only (6.7%, p < 0.05). The time to complete cure took longer in the stoma group (78.5 versus 57.0 days, p < 0.05) and was associated with a larger ulcer size (25 versus 16 cm2, p < 0.01). After correction for the ulcers' size, there was no association to outcome parameters such as overall success, healing time or adverse events. The presence of a diverting stoma alters the microbial flora of an anus-near decubitus slightly without impact on the healing process.