Nonsurgical Treatment of Pressure Ulcers Follow-up

  • Author: Christian N Kirman, MD; Chief Editor: Lars M Vistnes, MD, FRCSC, FACS   more...
 
Updated: Jan 11, 2012
 

Further Inpatient Care

  • Patients may benefit from transfer to a subacute or rehabilitation facility following wound closure. This allows for ongoing education, observation, and rehabilitative therapies prior to returning to their usual place of residence.
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Further Outpatient Care

  • Patients also may benefit from visits from a home health care organization once they return home. This may ease the transition and ensure that pressure avoidance strategies are adapted to the home and continued over the long term.
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Inpatient & Outpatient Medications

  • Spasticity should be alleviated and adequate nutrition maintained in the outpatient setting to prevent recurrence or new ulceration.
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Deterrence/Prevention

  • The ultimate success or failure of pressure sore healing only begins with wound closure. Prevention of recurrence and new ulceration then becomes the goal. Long periods of uninterrupted pressure should still be avoided through frequent repositioning. Pressure dispersion through the application of specialized support surfaces on beds and wheelchairs should be extended through the wound healing period and into the outpatient setting if available and tolerated by the patient. These products are an adjunct to and not a replacement for alternating weight-bearing surfaces.
  • Skin care should be performed daily. This involves a careful inspection of all skin surfaces to identify areas of impending breakdown prior to their occurrence. An often overlooked but necessary detail is to remove compression stockings and inspect the heels. Skin should be washed with soap and water and completely dried at regular intervals and immediately upon soiling. Moisture should not accumulate on the skin or in clothing or bedding, nor should one allow the skin to become overly dry and scaly. Skin moisturizers are useful to maintain the appropriate level of moisture at the skin surface.
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Complications

  • Complications fall into 1 of 2 categories: complications of chronic ulceration and complications of ulcer reconstruction.
  • Although uncommon, grossly infected pressure sores leading to bacteremia, sepsis, myonecrosis, necrotizing fasciitis, or gangrene represent the most serious complication. Another serious complication of chronic ulceration is malignant degeneration, or Marjolin ulceration. Initially described by Marjolin in 1828 as a cancer arising in burn scars, malignant degeneration has been reported in chronic pressure sores. These malignancies are typically aggressive squamous cell carcinomas with a high likelihood of nodal metastasis at the time of diagnosis. Any longstanding nonhealing wound should alert the examiner to the need to perform a biopsy.
  • Complications as a result of reconstructive surgery are unfortunately considerable. These include hematoma, seroma, wound dehiscence, wound infection, flap necrosis, and recurrence.
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Prognosis

  • Even with the development and implementation of new pressure-relieving surfaces and an increase in awareness among health care providers, no studies have demonstrated a decrease in incidence or prevalence of pressure ulceration during the last 3 decades. More distressing, recurrence rates as high as 90% are reported in the literature.
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Patient Education

  • Patients and their support system must realize that it is their responsibility to avoid recurrent and new ulceration and that this is a lifelong process.[23] Education on the proper avoidance of pressure should begin in the hospital and continue into the home.
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Contributor Information and Disclosures
Author

Christian N Kirman, MD  Plastic Surgeon, Department of Surgery, University of California, San Francisco, Medical Center

Christian N Kirman, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph A Molnar, MD, PhD, FACS  Director, Wound Care Center, 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, Undersea and Hyperbaric Medical 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

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wayne Karl Stadelmann, MD  Stadelmann Plastic Surgery, PC

Wayne Karl Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Don R Revis Jr, MD, to the development and writing of this article.

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Image of advanced sacral pressure ulcer shows the effects of pressure, shearing, and moisture.
Pressure ulcers of the lateral aspect of the right foot.
Heel pressure ulcer.
 
 
 
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