Recurrent Pressure Ulcers Research Articles

The Thoracic Suspension Orthosis-A Seating Option For Patients With Pressure Ulcers

Background/Objective: For patients with pressure ulcers, wound healing and prevention are important steps in reducing disability. Ulcers that fail to heal adequately may interfere with normal sitting. By relieving pressure, the thoracic suspension orthosis (TSO) may allow some patients with recurrent pressure ulcers to return to sitting and sit for longer periods.Methods: In this retrospective case series, 6 patients with chronic pressure ulcers were managed with TSO. Each patient had at least one of the following: (1) severe, non-healing pressure ulcers unresponsive to standard therapy, (2) recurrent ulcers requiring multiple surgeries, (3) chronic pain associated with sitting, or (4) bilateral lower extremity amputation resulting in instability or ischial pain in the seated position.Results: Each participant had a favorable functional outcome. Patients were able to resume modified sitting. Others were able to sit for longer periods. Some have used the TSO for long-term management.Conclusions: A TSO is an additional seating option for patients with chronic pressure ulcer, chronic pain associated with sitting, or bilateral lower extremity amputation. It is recommended after less restrictive, conservative measures have failed. In some patients, it has been used in lieu of extreme surgical measures.

Surgical treatment of pressure ulcers: 20-year experience

Schryvers OI, Stranc MF, Nance PW. Surgical treatment of pressure ulcers: 20-year experience. Arch Phys Med Rehabil 2000;81:1556-62. Objective: To review the outcomes of surgical management of spinal cord injury (SCI) patients with severe pressure ulcers and to examine likely risk factors for recurrence of pressure ulcers. Design: A retrospective medical record review. Setting: An SCI unit in a tertiary care facility. Patients: All admissions to the SCI unit for grade 4 pressure ulcers from 1976 to 1996. Intervention: Surgical repair of pressure ulcers. Main Outcome Measure: Complication and recurrence rates of pressure ulcers. Results: Of 598 pressure ulcers, 468 were pelvic area ulcers, of which 431 (92%) were treated surgically. Fifty-three had split-thickness skin grafting, and 380 were treated with 421 surgical procedures (253 fasciocutaneous or cutaneous flaps, 93 muscle or musculocutaneous flaps, 75 primary closures). One hundred eight (26%) of these procedures required some bone work. Suture line dehiscence occurred in 130 (31%), with 45 (11%) requiring reconstruction and 8 (2%) requiring skin grafting to heal. At discharge, 38 (9%) of these pelvic ulcers had not healed. Recurrent admissions occurred in 90 (54%) of the patients. Recurrence of ulcers at the same site occurred in 31% of the total number of ulcers and at a different site in 21%. At the time of the 415 admissions, 336 (81%) of the patients were unemployed; 159 (38%) had grade 8 or lower level of education; and 226 (55%) lived alone or with family but were independent in self-care. Of the 168 patients studied, 45 (27%) were aboriginal (Canadian native), and 59 (35%) had a history of drug or alcohol abuse. Conclusions: The vast majority of severe pressure ulcers were surgically treated. Complication and recurrence rates are similar to previous reports. Psychosocial problems (unemployment, low level of education, drug or alcohol abuse, poverty in the native communities) appear to increase the risk for pressure ulcer development. © by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Myelodysplasia in adult life: the value of an outreach nursing service.

In the state of South Australia, infants with myelodysplasia have been treated by early intervention since 1963, and the majority have survived. Many are now adults, leading active lives despite having severe disabilities. A pilot study confirmed that this population has a high incidence of preventable ill health because of recurrent urinary infections, renal damage, and pressure ulcers. Many of these complications can be prevented by an outreach nursing service aimed at providing education in self-care, counseling, advocacy, and other appropriate nursing interventions, thus allowing clients to avoid hospitalization and maintain their independence. The study also showed that many clients were unaware of important social benefits, the knowledge of which should promote their financial independence. The outreach nursing service is an essential part of an integrated long-term support program for adults with myelodysplasia and other forms of congenital spinal paralysis.

V-Y Advancement Flaps

V-Y advancement modification of skin paddle design for the biceps femoris, tensor fascia lata, transverse lumbar, and gracilis flaps permits readvancement of each of these flaps for recurrent pressure ulcers. Our use of this refinement of these flaps over the past twelve years shows that up to two readvancements of each of these flaps can be done, thus preserving reconstructive options in a patient population prone to pressure ulcer recurrence.

The biceps femoris myocutaneous advancement flap: a useful modification for ischial pressure ulcer reconstruction.

We describe a modification of the biceps femoris myocutaneous flap for reconstruction of ischial pressure ulcer defects. In this modification, all neural and vascular pedicles are preserved and the flap is advanced into the ischial defect rather than transposed as described in the literature. With this method, no transferred tissue is lost. Besides ensuring good tissue survival, the flap preserves a maximum number of reconstructive options in the event of ischial pressure ulcer recurrence. These advantages make the biceps femoris myocutaneous advancement flap our first choice for reconstruction of ischial pressure ulcer defects.

Recurrence of pressure ulcers

Recurrence of pressure ulcers

Recurrence of Pressure Ulcers in Paraplegic Patients

To the Editor. — This letter refers to the article entitled Recurrence of Pressure Ulcers: A Study of Five Cases, by Dr J. Elizabeth Morgan (236:2430, 1976). On the basis of my seven years' experience on a Veterans Administration Hospital neurosurgical service, I believe that the recurrence of pressure ulcers in a paraplegic patient represents a suicide attempt. Management of this aspect of the patient's illness may be more effective than frequent examination of the skin by a surgeon. Or, it may not be.

Recurrence of pressure ulcers in paraplegic patients

Recurrence of pressure ulcers in paraplegic patients

Recurrence of Pressure Ulcers

THE RECURRENT pressure ulcer is a surgical failure in which not all contributing factors may be recognized. Even major rehabilitation centers struggle with a certain number of recurrences.^1-3In 1964, Dansereau and Conway³reported the surgical treatment of 2,000 pressure ulcers. Recurrences developed in 5% of ischial ulcers, 14% of trochanteric ulcers, and 15% of sacral ulcers. We have cared for five paraplegic patients, all of whom had prolonged hospital courses because of recurrent pressure ulcers. In each of our five patients, their own carelessness contributed to recurrence. <h3>Report of Cases</h3> Five paraplegic patients were treated consecutively for recurrent pressure ulcers at the New England Medical Center Hospitals from September 1973 to October 1974. Each patient was paraplegic as a result of trauma and had undergone full rehabilitation in one or more institutions. Four of the five patients were under 30 years of age. Three were living at

Recurrence of pressure ulcers. A study of five cases

Recurrence of pressure ulcers. A study of five cases