Surgical Reconstruction of Pressure Ulcers
Pressure sores result from pressure breakdown in areas that bear seated weight, such as ischial tuberosities of spinal injury patients, and in areas with pressure due to devices, such as splints, ear probes, or rectal tubes. Decubitus ulcers occur over ar
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Tushar Patel, Eric G. Wimmers, Matthew Pontell, and Adam Saad
Introduction Terminology In its most basic terms, pressure sores are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. Pressure sores result from pressure breakdown in areas that bear seated weight, such as ischial tuberosities of spinal injury patients, and in areas with pressure due to devices, such as splints, ear probes, or rectal tubes. Decubitus ulcers occur over areas that have underlying bony prominences when the individual is recumbent, e.g., the sacrum, trochanter, heel, and occiput. Pressure is the most likely cause among many other factors that contribute to the development of pressure sores and hence is the most important etiologic factor. Pressure sores do not only occur in the elderly or in people who are getting poor care. A pressure ulcer can happen to anyone who is in some sort of debilitated state. Unfortunately, healthcare provid-
T. Patel, MD (*) • E.G. Wimmers, MD • A. Saad, MD The Plastic Surgery Center, Institute for Advanced Reconstruction, 535 Sycamore Ave, Shrewsbury, NJ 07702, USA e-mail: [email protected]; [email protected]; [email protected] M. Pontell, MD Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102, USA
ers may not aggressively evaluate patients routinely for pressure ulcers, which may be found incidentally while treating something else. Physical therapists tend to spend a lot of time with their patients. In a rehab or skilled nursing setting, a therapist may be with the patient for 1–2 h a day. A therapist might catch a glimpse of a pressure sore on a patient’s sacrum while walking them to the bathroom. A pressure sore on the heel may be noticed while a therapist puts socks on their patient for ambulation. It is important to remember, even if you are not treating the wound or the pressure ulcer yourself, you might be the one to find it.
Epidemiology A broad inquiry reviewing over 400,000 records from a survey between 1989 and 2005 found overall rates between 9.2 % in 1989 and 15.5 % in 2004 [1]. Rates were higher in long-term acute care facilities, at 27.3 % [2–4]. Overall, pressure ulcer prevalence appears relatively stable despite significant advances in treatment and prevention. Particular populations have been identified at higher risks. Hip fracture patients are at particularly higher risk for pressure sores ranging from 8.8 to 55 % [5–9]. Spinal cord injury (SCI) patients are also at particular risk for pressure sores due to the combination of immobility and insensitivity with reported rates between 33 and 60 % leading to the second leading cause of rehospitalization in these patients [10–15].
© Springer International Publishing Switzerland 2017 A.I. Elkwood et al. (eds.), Rehabilitative Surgery, DOI 10.1007/978-3-319-41406-5_14
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Economic Burden Pressure sores are a costly problem for the healthcare system. Direct cost calculations are
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