Sacral Decubitus Research Articles

Das drackgeschwür bei querschnittgelähmten — eine vergleichende klinisch-histologische untersuchung

331 pressure sores of 141 patients with paraplegia were investigated histologically, the results were partly correlated with the roentgenological features. The level of the spinal cord lesion was the segment Th12-L1 in 45%, the decubital ulcers were mostly localized above the os ischiadicum (64%). A pseudocancerosis was diagnosed in 14.2%, one time a cancer in a sacral decubitus has been found. The inflammation was limited to the soft tissue in 56.9%, in 28.5% a chronic osteomyelitis of different severity had developed. In 73.6% of the patients with a histologically proven osteomyelitis this osteomyelitis could be diagnosed roentgenologically too. The high amount and severity of the dermal and bony lesions justifies the radical surgical therapy of the pressure sores, which is practised today. Our investigations of chronic pressure sores did not point out new aspects of aetiology of pathogenesis--this is only possible by experimental models.

Gluteus maximus musculocutaneous island flaps and their use in sacral decubitus ulcers

Gluteus maximus musculocutaneous island flaps and their use in sacral decubitus ulcers

A gluteus maximus myocutaneous island flap for the repair of a sacral decubitus ulcer

The gluteus maximus myocutaneous island flap is a useful, safe and versatile flap for the repair of sacral decubitus ulcers. It is now our recommended procedure of choice for the surgical treatment of this type of wound ( Maruyama and Tajima, 1978).

Building Staff Rapport between Institutions

thopedic surgical unit at our hospital and said, "You look very happy today." He smiled. "I am," he replied. "I'm going home today. I like it here, but I like it better where my friends are." Going home for Mr. Long, a 75-year-old man hospitalized for a hip pinning of a fractured left femur, meant returning to our geriatric facility, where he had been a resident for two years. Upon his arrival, the geriatric nurses accompanied him to his room, and as he was helped into bed, a discovery was made that immediately precipitated a flurry of memos and phone calls. The nurse discovered that Mr. Long had a small sacral decubitus ulcer.

Bacterial Endocarditis Associated With a Permanent Transvenous Cardiac Pacemaker

To our knowledge, the first case of acute bacterial endocarditis in a patient with a permanent pervenous cardiac pacemaker occurred on the mural endocardium of the right atrium along the course of the pacemaker catheter. It is suggested that bacteremia, probably originating from a sacral decubitus ulcer, resulted in implantation of organisms on the damaged atrial endocardium with subsequent septic embolization.

Bacterial endocarditis associated with a permanent transvenous cardiac pacemaker

To our knowledge, the first case of acute bacterial endocarditis in a patient with a permanent pervenous cardiac pacemaker occurred on the mural endocardium of the right atrium along the course of the pacemaker catheter. It is suggested that bacteremia, probably originating from a sacral decubitus ulcer, resulted in implantation of organisms on the damaged atrial endocardium with subsequent septic embolization.

Meningitis complicating sacral decubitus ulcer.

To the Editor.— Cerebrospinal menigitis as an extension from epidural and retroperitoneal abscesses became the fatal complication of a bed-ridden patient with a sacral decubitus ulcer. Report of a Case.— A 54-year-old woman with severe rheumatoid arthritis, a temperature of 103 F, and a sacral decubitus ulcer for a month before admission had received little care at home and lay on her back continuously. She consumed alcohol to ease her arthritic pain and add color to her waning existence. After a week of pain in the back and malaise, this febrile, debilitated, arthritic woman appeared older than her stated age. Ankyloses of legs and neck were severe. A decubitus ulcer, 8×6 cm in size, over the sacrum extended completely through the subcutaneous tissue down to the bone. The wound was debrided extensively and cleaned daily. The white blood cell count (WBC) was 19,250/cu mm, with 87% neutrophils. Sacral x-ray film

Albumin-Induced Elevation Of Alkaline Phosphatase

To the Editor.— It has been suggested that the placental components of certain commercial albumin preparations might induce elevations of alkaline phosphatase levels in the serum of patients who received them. 1 We recently encountered such a case and present it as an example of the diagnostic confusion which may result. Report of a Case.— A 58-year-old man with a 30-year history of multiple sclerosis was acutely ill on admission to the New England Medical Center on May 26, 1970, because of bacteremia. The temperature was 103 F, the blood pressure was 90/50 mm Hg, and the white blood cell count (WBC) was 28,000/cu mm. A large sacral decubitus ulcer appeared to be healing well. The patient was treated with intravenously administered kanamycin sulfate and cephalothin sodium, and fluids which included 500 ml of 5% normal human serum albumin (Albuspan). Laboratory studies showed the following values: alkaline phosphatase, 8.6 Bodansky

Exposure and natural fixtion of split-thickness skin grafts.

Success in free skin grafting is dependent on adequate contact of the graft with a vascular supply and the control of infection. Conventional methods of achieving these two important goals incorporate the principle of grafting only surfaces which are free of infection with techniques of fixation of the graft by sutures and retentive dressings, plus immobilization of the graft and its bed by inlay molds and external splints. Common practice and current teaching traditionally hold to the concept that mechanical fixation and pressure dressings are prime requisites for successful skin grafting. Too often, no differentiation has been made in the application of this teaching to the grafting of full-thickness and splitthickness skin. In 1954 a large single-sheet split-thickness graft was applied to a granulating sacral decubitus area by simply laying the graft on its bed, without the use of sutures or dressings. Complete survival of the graft resulted. Failure of

Reconstructive surgery in paraplegia

Summary Because of improved medical and surgical care. paraplegics can look to the future with confidence. Their care is a group endeavor. with each specialist playing an important role in the patient's rehabilitation. The routine care of these patients consists primarily of cleanliness of the skin and decubitus ulcers. good nutrition. prevention of urinary tract complications and physiotherapy. The detailed regimen used to maintain these patients during the surgical phase of their rehabilitation has been outlined herein. The most common sites for ulcers are the sacral. ischial and trochanteric regions. A retrograde pedicle flap. based on the gluteal circulation. is the one of choice for resurfacing sacral ulcers. The transverse flap elevated above the ulcer on the back seems to be better for some large sacral decubitus ulcers. Because of the increased incidence of ischial ulcers as the patient assumes the sitting position. the resection of the ischial bursa, tuberosity and adjacent bones as a prophylactic measure in paraplegics seems to be justified. Following the resection of any ischial ulcer. primary repair should be performed if possible. A retrograde flap raised on the anterolateral aspect of the thigh is chosen to close a trochanteric ulcer. The base of the flap. rather than a skin graft. then lies under the brace. The plastic surgeon is constantly striving to improve his technic for keeping the skin surface intact. enabling the paraplegic to become ambulatory. care for himself, and often make a real contribution to society.