Treatment Of Pressure Sores Research Articles

Osteomyelitis in Late-Stage Pressure Sore Patients: A Retrospective Analysis.

Late-stage pressure sore (PS) patients are particularly susceptible to osteomyelitis (OM), as bony prominences commonly constitute the focal point of the ulcer. There are lack of data regarding the associated factors and the clinical relevance of this diagnosis in the context of PS treatment. This retrospective analysis investigated the clinical characteristics, blood markers indicative of infection in PS patients, and development of histologically evident OM. A total of 125 patient were included from 2014 to 2019. The patient records were especially scanned for histological diagnosis of OM. OM was detected in 39% (37/96) of the samples taken during the index procedure. OM prevalence increased to 56% (43/77) at the second and 70% (41/59) at the third debridement. Therefore, the diagnosis of OM was acquired during treatment in 35 cases. Patients diagnosed with initial OM presented significantly higher blood markers, indicative of infection upon admission. Only patients with consistent OM (three positive biopsies) showed higher flap revision rates. This study found no compelling evidence linking OM to worse clinical outcomes in PS patients. In the absence of elevated inflammatory markers, reducing bone biopsy frequency and adopting a less aggressive bone debridement approach may help prevent OM in PS patients.

Palliative care at the present stage in Krasnoyarsk

Palliative medicine, aimed at ensuring the quality of life of patients with severe and incurable diseases, is becoming increasingly important in medical practice. In this article, we consider the current state and prospects for the development of palliative medicine in the city of Krasnoyarsk. The study showed that the number of patients in need of palliative care is increasing, mainly people older than working age with diseases of the cardiovascular system and oncological diseases. Approaches to anesthesia, prevention and treatment of pressure sores in hospice patients are described. The problems include a lack of qualified personnel and violations of the socio-psychological status of medical personnel, limited access to palliative medicine for remote areas of the region.

Wound Healing Potential of Polyherbal Dusting Powder for the Treatment of Bedsores

A bed sore is also known as a pressure sore and is an open ulcer on the skin. Bedsores are mostly found on the skin that covers bony areas. The primary objective of this research project was to develop and test the polyherbal dusting powder containing an aqueous extract of Azhadirachta indica, Curcuma longa L., Aloe vera, and Tagetes erecta. The preliminary phytochemical investigation of aqueous extract was carried out. Selected herbs have anti-inflammatory, antimicrobial and wound-healing action needed for the treatment of bedsores. The powder was then tested for physical parameters like color, texture, smell, form, and pH), and micrometric parameters like size of particles, angle of repose, Hausner’s ratio, surface area, and other flow properties. The dosage form has been screened for antimicrobial activity against Escherichia coli, Bacillus subtilis and Staphylococcus aureus. The formulation showed significant antimicrobial activity as compared to the standard povidone iodine drug. In the skin irritation and wound healing studies performed on albino wistar rats, significant effects were observed with 200 mg of powder. According to the in-vivo study, polyherbal dusting powder has been shown to be effective in the treatment of bedsores and can be further investigated.

Multifunctional electrospun polycaprolactone/chitosan/hEGF/lidocaine nanofibers for the treatment of 2 stage pressure ulcers

In this study, a multifunctional nanofiber dressing that can promote antibacterial, analgesic and healing was prepared by electrospinning technology. Hydrophobic polycaprolactone (PCL)/chitosan (CS)/lidocaine hydrochloride (LID) and epidermal growth factor (EGF) were used as scaffold materials and dissolved in trifluoroacetic acid to prepare spinning solution. The morphology of PCEL dressing was observed by scanning electron microscopy. The fiber structure was dense and the average diameter was 297.0 nm. The water absorption capacity test and water contact angle measurement showed that the fiber had good water absorption and hydrophilicity (1302 %, 139.258°). Drug release was 84 % within 60 h. In the results of antibacterial experiment, the dressing showed certain antibacterial properties. The results of cell experiments show that the dressing can promote cell proliferation. In addition, coagulation experiments showed that the dressing could quickly coagulate the blood within 4 min. In addition, PCEL dressing promoted collagen deposition and vascularization through animal models of pressure sores. Therefore, multifunctional dressing can be used as an ideal auxiliary means for the treatment of pressure sores, and it is a promising alternative to chronic wound healing.

What is the most effective topical method for preventing presacral pressure sores that occur after hip fractures?

Pressure sores are frequently observed in patients hospitalized due to hip fractures. This condition is caused by pressure, shearing forces, and friction on the skin and subcutaneous tissues. During the preoperative preparation period leading up to surgery, patients often remain immobile due to pain, lie in a supine position, and must use incontinence products because they cannot meet their toileting needs. Incontinence-related dermatitis is observed in patients using incontinence products, which constitutes a fundamental cause for pressure sore development. Since hip fractures are generally seen in the elderly population, advanced age, nutritional disorders, moist skin, infection, and metabolic diseases (e.g., diabetes, kidney failure) are frequently associated, serving as additional factors that facilitate pressure sore formation. Once a pressure sore develops, its treatment is lengthy and costly. Therefore, reducing pressure and addressing risk factors is crucial for prevention and treatment. The choice of treatment methods may vary according to the severity of the wound. In addition to systemic treatments, local topical treatments, including alleviating pressure and shearing forces, wound care, prevention of incontinence-related dermatitis, and nutritional regulation, are essential. Surgical treatment procedures may be necessary in advanced cases.
 Comparison of local topical treatment alternatives that can be applied before surgical treatment has not been conducted in the literature. This study aims to find the most effective method to address this significant problem by comparing three different materials and a control group applied in our clinic.
 This study particularly focuses on the topical treatment of presacral pressure sores occurring after hip fractures and is the first and only study in the literature.
 Presacral pressure sores are frequently observed in hip fractures, and the most effective method for preventing their formation and maceration is the application of barrier cream pads and barrier spray after isotonic cleansing.

Effectiveness of zinc therapy for the treatment of pressure ulcers.

Pressure ulcers are a significant burden in healthcare settings, impacting patients' lives and incurring substantial costs. Nutrition, including the micronutrient zinc, plays a role in wound healing. However, controversy exists regarding zinc supplementation for pressure ulcer management. Further research is needed to determine the efficacy, optimal dosages, and safety of oral zinc supplementation. This commentary provides a critical appraisal of the systematic review conducted by Song et al (2020), which evaluates the efficacy of zinc therapy in the treatment of pressure sores, focusing on the implementation of the nutritional recommendations in context to practice.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft.

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

Use of fibrin glue in the treatment of decubital ulcers in patients after brain damage, as a stage of conservative treatment

BACKGROUND: Patients with brain damage require specific treatment for decubitus ulcers. Given the seriousness of their condition and decompensation of concomitant pathology, surgical treatment is not always possible. Conservative therapy can take a long time, which is aggravated by the unsolvable problem of patient immobilization, microcirculatory tissue disorders, and inevitable chronicity of the purulentinflammatory process. Most authors and practitioners are inclined toward a combined approach in the treatment of decubitus ulcers. AIM: To evaluate the results of using fibrin glue in the treatment of bedsores in patients with severe brain damage. MATERIALS AND METHODS: The article presents the experience of using fibrin glue in the conservative treatment of bedsores. The study included patients in a chronic critical state because of severe brain damage, with a decubitus ulcers area of 80 cm2 (stage III according to the Agency For Health Care Policy and Research classification). In the main group, treatment included the use of fibrin glue in accordance with the Russian Federation Patent No. 2777483 dated 08/04/2022. In the control group, treatment included standard dressings with levomekol ointment. Both groups received treatment for 21 days. Changes in the wound process were assessed using the BatesJensen scale and cytological examination at control points. RESULTS: The study analyzed 58 patients, who were divided into two groups: group 1 (main) included 32 patients (15 men, 17 women), and group 2 (control) included 26 patients (12 women, 14 men). In the main group, after 1 week of applying dressings with fibrin glue, positive changes were noted, such as active marginal epithelialization, disappearance of undermining and swelling of wound edges, appearance of juicy bright granulations, and absence of exudates. After 22.5 weeks, epithelialization exceeded 50% of the total area of the decubitus ulcers (56.2% of cases), and exudation was completely absent. In a cytological study, the percentage of cells responsible for tissue proliferation increased and inflammation decreased in the main group. No significant effect was noted in the control group. In 7.7% of cases, 50% epithelialization was noted on days 2835; in three patients, re-infection of the decubitus ulcers occurred, and ischemia developed, which significantly lengthened the total duration of inpatient treatment and rehabilitation by 1.01.5 months. CONCLUSION: The use of fibrin glue promotes decubitus ulcers epithelization, thereby reducing their size, up to complete healing.

The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients.

Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the 'Scale for the Assessment of Narrative Review Articles' (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.

Role of autologous platelet rich plasma (APRP) in pressure sore

Patients with chronic conditions who are bedridden or immobile for extended periods of time frequently have pressure sores. Deep tissue infections caused by them may spread to include deeper structures like bones and cause severe morbidity. APRP has aided as an adjuvant therapy to optimise results in a variety of plastic surgical applications. In our case report, we go through how Autologous Platelet Rich Plasma (APRP) can be used in conjunction with other treatments to treat pressure sores.

Pressure sore incidence and treatment in left ventricular assist device (LVAD)-equipped patients: Insights from a prospective series

A left ventricular assistance device (LVAD) is indicated in patients with end-stage heart failure. Due to the non-physiologic blood flow, a LVAD may favor pressure sores with a devastating risk of infection. This work shows the prevalence and treatment of pressure sores in LVAD patients, to optimize their management. We retrospectively investigated all LVAD implantations at the Lausanne University Hospital (CHUV) from 2015 to 2019. We detected patients who developed a pressure sore and evaluated the timeline, management, and outcomes. Forty-two patients benefited from LVAD, among whom 5 (12%) developed a stage III/IV pressure sore, within a mean time of 25 days. Due to their poor overall condition, 4/5 patients were treated surgically and 1/5 conservatively. Half of the patients treated with surgery had major complications requiring reoperation. After flap coverage, the mean time to healing for patients was 6 weeks. The rapid development of deep pressure sores seen in 12% of patients may be a manifestation of the maladaptive blood flow induced by LVADs, combined with their bedridden condition. Initial signs of pressure sores should be considered seriously, as they are rapidly evolving and needing an aggressive surgical treatment whenever possible (80%). Complication rate was similar compared to standard pressure sore flap treatment. All patients benefiting from flap surgery achieved effective coverage after a mean follow-up of 24 months. No patient developed a LVAD infection. Surgery must be considered early in this population to prevent potential device infection.

Facial Pressure Sores in COVID-19 Patients during Prone Positioning: A Case Series and Literature Review.

Background:COVID-19 has been a source of several stays in intensive care units, increasing the number of prone positioning. In parallel, complications increased, such as facial ulcers. Herein, we present a literature review and a case series about facial pressure sores in COVID-19 patients during prone positioning. This study aimed to show that such facial pressure sores may require surgical intervention in specific cases.Methods:We performed a search of the literature with the Pubmed database, and we selected 13 articles for review. Therefore, we analyzed the results among the most frequent locations of facial ulcers: cheeks, ears, lips, nose, and chin. We also reported three original clinical scenarios with a gradual surgical approach to address facial pressure sores from less invasive to more invasive surgery (corresponding to the reconstructive ladder strategy) during the COVID-19 period.Results:We identified 13 articles related to the topic. Only four clinical cases discussed a surgical treatment but only for complications such as bleeding, infection, and sequelae after long-term management. Faced with a lack of literature about surgical options, we reported our case series showing that surgical treatments could be increasingly complex among the sore grades. The following surgical approach was selected: debridement, skin graft, and local or free flaps.Conclusions:Surgical intervention is the last course of treatment for pressure sores. However, the need for later surgical revision cannot be excluded, especially regarding the face, in case of dyschromia or retraction affecting the facial aesthetic subunits.

Activation of Tissue Reparative Processes by Glow-Type Plasma Discharges as an Integral Part of the Therapy of Decubital Ulcers

The results of a clinical study of the complex treatment of pressure ulcers using the method of activation of reparative processes in tissues by cold plasma discharges initiated by high-frequency current are presented. Activation was carried out with a specialized device generating cold plasma discharges at frequencies of 0.11, 2.64, and 6.78 MHz. It was shown that the process of activation in the skin and muscle tissues of the bedsore zone proceeds most efficiently when using a current with a frequency of 6.78 MHz as compared to currents with a frequency of 2.64 and 0.11 MHz. For a needle electrode with a diameter of 0.3 mm, the optimal exposure parameters were power—(5.0 ± 1.5) W and time—(2.0–3.0) s. The results of the analysis of histological samples, histochemical, and bacteriological analysis confirmed the effect and showed the dynamics of the process of activation of reparative processes in the tissues of the bedsore wound under the influence of cold plasma discharges and a decrease in microbial contamination. The most pronounced effect of activation was formed during the period from 14 to 21 days. The effectiveness of therapy by the method of activation of reparative processes with cold plasma discharges, according to the criterion of the rate of wound healing, ranged from 14 to 16%, depending on the etiology of the decubitus wound. It is concluded that the activation of tissue reparative processes by glow-type plasma discharges as an integral part of the treatment of decubital ulcers is an effective link in the complex treatment of pressure sores.

Construction and Application of a Three-Level Linkage System for the Prevention and Treatment of Pressure Sores in Geriatric Patients in the Henan Province, China.

To research effective prevention and treatment strategies for pressure sores in geriatric patients and examine the results from application of a three-level linkage system. We developed and constructed a three-level linkage intervention system for pressure sores from Jun 2017 to Dec 2018, centered at the geriatrics department of the Ninth People's Hospital of Zhengzhou, China. The changes included improving the organization structure; formulating a unified evaluation system for quantitation of pressure sore risk management; formulating and standardizing the reporting/feedback mechanism; constructing and improving three-level linkage system staff training; and establishing a quality control system for process monitoring guidance and final evaluation feedback. The incidence of pressure sores significantly decreased, nursing staff's knowledge level regarding pressure sore prevention and treatment increased, and pressure sore cure rate and care satisfaction increased. Implementation of a three-level linkage intervention system for pressure sores in geriatric patients and standardizing pressure injury assessment helps achieve pressure sore prevention and early intervention, effectively reduces the occurrence of pressure sores in geriatric nursing homes, increases the cure rate, and improves care satisfaction among patients.

A computational framework to support the treatment of bedsores during COVID-19 diffusion.

The treatment of pressure ulcers, also known as bedsores, is a complex process that requires to employ specialized field workforce assisting patients in their houses. In the period of COVID-19 or during any other non-trivial emergency, reaching the patients in their own house is impossible. Therefore, as well as in the other sectors, the adoption of digital technologies is invoked to solve, or at least mitigate, the problem. In particular, during the COVID-19, the social distances should be maintained in order to decrease the risk of contagion. The Project Health Management Systems proposes a complete framework, based on Deep Learning, Augmented Reality. Pattern Matching, Image Segmentation and Edge Detection approaches, to support the treatment of bedsores without increasing the risk of contagion, i.e., improving the remote aiding of specialized operators and physicians and involving inexperienced familiars in the process.

The role of nurses in the application of bedsores in palliative care

In palliative care, the role of the nurse is very important in the prevention of bedsores, as only by providing qualified care and early prevention can bedsores be prevented and thus improve the patient's quality of life in the last years of life. The role of nurses in the prevention of bedsores is mainly reflected in the use of bedding prevention and treatment mattresses and functional beds. Less than three-quarters of nurses often use biophysical agents, various bandages, auxiliary surfaces, heel guards, stationary lifts, flip-flops, transfer boards / stretchers / belts, and other positioning devices in palliative care. According to the recommendations of the EPUAP, almost half of nurses say that the most effective means of preventing bedsores in palliative care is flipping. Nurses perform many professional and effective actions, functions that improve the patient's health and well-being in the treatment of bedsores. Also, in the prevention of patients' bedsores and palliative care, nurses perform their work responsibly, reliably, and are able to empathize with patients.&#x0D; The aim. To elucidate the role of nurses in the application of bedsores in palliative care.&#x0D; Research methods: after analyzing the scientific literature, from 2021. A quantitative survey and an anonymous survey were conducted in November-December. The research data were analyzed by MS Office Excel 2016 data processing program. The research was conducted in accordance with ethical principles.&#x0D; Results of the study: 64 nurses (women) participated in the study. The productive role of nurse in the prevention of bedsores is reflected in the use of EPUAP guidelines in the prevention of patient bedsores.&#x0D; Conclusions: The study found that 94 percent. (n = 60) the role of nurses in the prevention of bedsores is reflected in the most common use of bedsores for the prevention and treatment of bedsores, 91%. (n = 58) - uses functional beds. On average, 67 percent. (n = 43) nurses often use biophysical agents, various bandages, auxiliary surfaces, heel guards, stationary lifts, flip-flops, transfer boards / boards / stretchers / belts and other positioning devices, with the least use of implants - 39%. (n = 25). According to the EPUAP, 46 percent. (n = 29) The most effective measures for nurses in the prevention of bedsores in palliative care are reversal, and 17%. (n = 11) - when more employees work, 11 percent. (n = 7) - patient hygiene and dry maintenance, 8 percent. (n = 5) - bed rest mattresses and functional beds.

Pressure sores-Amultilayered challenge

Pressure sores occur when soft tissue of the skin, subcutaneous fat tissue or musculature is exposed to pressure or friction over along period of time, which leads to local ischemia with subsequent necrosis. All areas of the skin lying over bones with only athin layer of soft tissue are predilection sites. In older patients the risk factors for the development of apressure sore must be systematically documented at admission and during the course of the disease. Accordingly, the necessary prophylactic procedures must be initiated. The classification of the European Pressure Ulcer Advisory Panel (EPUAP) is used to describe a pressure sore. For the differential diagnosis, incontinence-associated dermatitis and a manifest peripheral artery occlusive disease must be excluded. The treatment consists of positioning procedures and local and systemic supportive wound treatment. In cases of deep pressure sores, coverage by plastic surgery can effectively accelerate healing. The multiprofessional geriatric team has the appropriate prerequisites for comprehensive treatment of pressure sores.

ASSESSMENT OF THE RISK OF DECUBITUS ULCERS USING BRADEN SCALE

Purpose: Within the behavioral guidelines of hospitalized patients who need compensatory nursing care, an assessment of the risk of decubitus ulcers is recommended to be done at regular intervals, in schedule, and after each altered state. The goal of this research is to apply the BRADEN SCALE for assessment of the risk of decubitus ulcers occurring during a hygienic toilet in sick people who need compensatory nursing care. Material/Methods: An assessment of the risk of decubitus ulcers via using the Braden scale is applied in 120 hospitalized patients during a hygienic toilet. Treatment of decubitus ulcers I and II degree is being performed when the state of the skin and wounds that have already occurred are being established. For processing, analysis and graphic presentation of the results and data, the statistic program SPSS 20.0 is being used. Results: It's reported that 50, 83% of the respondents have got quite a risk of decubitus wounds occurring, 26,67% are at great risk, and 14,17% are at moderate risk. Only 8, 33% of all patients tested are at light risk. Conclusions: In all patients tested, a various degree of decubitus wounds occurrence, is reported. This defines the importance of the nurses' hygienic care and activities for the prevention of decubitus ulcers to occur. If the prevention measures of patients who have gotten in a risk group are not observed, every decubitus wound leads to a continuous stay in the hospital and also additional treatment and tests, which automatically prolong and raise the cost of hospital treatment.

Impact of learning program on enhancing nursing practice and knowledge in ulcer management: A systematic review

Background: Nurses who care for patients with pressure injuries often have to work longer shifts and may feel guilty or mentally distressed due to the development of the injury or the patients' delayed recovery. The purpose of this study is to evaluate how effectively nurses' knowledge and practices when providing care for patients with pressure injuries are supported by e-learning programs. Method: Our research was carried out in compliance with PRISMA criteria. To finish the systematic literature review, the databases MEDLINE, EMBASE, SCOPUS, and Cochrane were searched. We searched for "learning," "pressure ulcer," "pressure," "ulcer," "pressure ulcer," and "pressure injuries." Databases spanning 2010 to 2020 were included in the search period, and only English-language research was taken into account. Results: Six papers total—two non-randomized trials and four randomized control trials—were included in this systematic review. Nurses from intensive care units were involved in the majority of the included research. The NPUAP, PUKT, PU evaluation, PU evaluation, and EPUAP scales were used. The interventions used included bedsore treatment and prevention, pressure ulcer screening and treatment programs, and a program for training on the Braden scale and PU classification. The knowledge and practice were outcome measures. Conclusion: Our comprehensive study highlights the potential of e-learning programs to significantly enhance the knowledge and practice of nursing professionals in managing pressure injuries.

Molecular modeling, expression and wound-repair activity in vivo of platelet-derived growth factor from Periplaneta americana

Platelet-derived growth factors (PDGFs) promote the repair of the wounded tissue by stimulating macrophages to produce and secrete growth factors. Active constituents extracted from Periplaneta americana were primary for treatment of wounds, pressure sores, and burns. In this study, PDGF from Periplaneta americana (PAPDGF) was identified, and the sequence analysis, physical properties, 3D structure of PAPDGF and the interfaces of PAPDGF-PDGFRβ were predicted by bioinformatics. In addition, to explore the relationship between the key amino acid residues and activity of PAPDGF, recombinant mutant of PAPDGF (rmPAPDGF, D164H) was constructed. The sequence of PAPDGF and mutant of PAPDGF (D164H) were expressed and purified by Ni-affinity chromatography. The wound-repair activity of recombinant PAPDGF (rPAPDGF) and rmPAPDGF were tested in vivo. The results showed that rPAPDGF and rmPAPDGF were successfully obtained and exhibited a single band on SDS-PAGE at 49.87 kDa. The rPAPDGF showed potent repair activity by stimulating the expression of collagen and PDGFRβ, whereas the rmPAPDGF exhibited low repair activity in vivo, which indicated that the residue D164 in PAPDGF was the key amino acid to maintain activity. Taken together, PAPDGF may be served as a promising candidate agent for the treatment of wound in the future.