eMedicine Specialties > Plastic Surgery > Pressure Ulcers

Pressure Ulcers, Nonsurgical Treatment and Principles: Differential Diagnoses & Workup

Author: Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Coauthor(s): Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Jul 28, 2009

Workup

Laboratory Studies

  • CBC with differential may show an elevated white blood cell count indicative of inflammation or invasive infection, such as osteomyelitis.
  • Erythrocyte sedimentation rate should be obtained to evaluate for inflammation and infection.
  • Nutritional parameters should be evaluated to assess adequate nutritional stores needed for adequate wound healing. Lab studies include the following:
    • Albumin level
    • Prealbumin level
    • Transferrin level
    • Serum protein level
  • When indicated by the specific clinical situation, the following laboratory studies should be obtained:
    • Urinalysis and culture in the presence of urinary incontinence
    • Stool examination for fecal white blood cells and Clostridium difficile toxin when pseudomembranous colitis may be the cause of fecal incontinence
    • Blood cultures if bacteremia or sepsis is suggested

Procedures

  • A tissue biopsy should be performed of wounds that do not demonstrate clinical improvement despite adequate care and wounds in which tissue invasion by bacteria is suggested. This allows quantification and identification of bacterial species and their antibiotic susceptibilities. Biopsy also allows distinction between simple contamination and the more serious tissue invasion that is not revealed by the common practice of swabbing the wound surface for culture.
  • A bone biopsy should be performed for a stage IV pressure ulcer with exposed bone. If osteomyelitis is confirmed, treatment with a prolonged course of antibiotic therapy may be indicated.
  • A tissue biopsy of chronic wounds should be performed to rule out the presence of an underlying malignancy, called a Marjolin ulcer, which has been reported in chronic pressure sores as in other chronic wounds. If a chronic pressure sore has been stable for months or years but has recently deteriorated, a biopsy should be performed. Scar carcinoma is uncommon and typically occurs in wounds that have been open for many years.

More on Pressure Ulcers, Nonsurgical Treatment and Principles

Overview: Pressure Ulcers, Nonsurgical Treatment and Principles
Differential Diagnoses & Workup: Pressure Ulcers, Nonsurgical Treatment and Principles
Treatment & Medication: Pressure Ulcers, Nonsurgical Treatment and Principles
Follow-up: Pressure Ulcers, Nonsurgical Treatment and Principles
Multimedia: Pressure Ulcers, Nonsurgical Treatment and Principles
References
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References

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Further Reading

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Keywords

decubitus ulcers, pressure sores, ulcerations, pressure ulcers, surgical and nonsurgical treatment, decubitus, ischial tuberosity ulcer, ischemia, tissue necrosis, capillary filling pressure, shear forces, friction sores, maceration, microcirculatory occlusion, tissue anoxia, Shea classification, National Pressure Ulcer Advisory Panel, pressure reduction, tissue perfusion, sacrum ulcer, operative debridement, skeletal muscle relaxants, repositioning

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Contributor Information and Disclosures

Author

Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Christian N Kirman, MD is a member of the following medical societies: North Carolina Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine
Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Peripheral Nerve Society, and Wound Healing Society
Disclosure: KCI, Inc.  Honoraria Speaking and teaching; Integra Life Sciences Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Medical Editor

Albert E Cram, MD, FACS, Professor Emeritus, Departments of Surgery, Otolaryngology Head & Neck Surgery and Orthopedic Surgery, University of Iowa College of Medicine; Consulting Staff, Iowa City Plastic Surgery
Albert E Cram, MD, FACS is a member of the following medical societies: American Association of Tissue Banks, American Burn Association, American College of Surgeons, American Heart Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: ethicon Grant/research funds Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS, Professor of Surgery, Emeritus, Stanford University Medical Center
Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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