eMedicine Specialties > Plastic Surgery > Pressure Ulcers

Pressure Ulcers, Surgical Treatment and Principles: Workup

Author: Bradon J Wilhelmi, MD, Endowed Leonard Weiner, MD, Professor and Chief of Division of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Coauthor(s): Michael Neumeister, MD, FRCSC, FACS, Program Director, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2008

Workup

Laboratory Studies

  • Osteomyelitis is suggested by an erythrocyte sedimentation rate (ESR) greater than 120 mm/h and a WBC count greater than 15,000/µL.
  • Preoperative nutritional status can be determined by obtaining the patient's albumin level, which should be optimized to at least 3.5 g/mL prior to flap reconstruction. These patients often have anemia of chronic disease, suggested by a low mean corpuscular volume, and can be considered for a transfusion in order to achieve a preoperative hemoglobin level greater than 12 g.

Imaging Studies

  • Diagnosis of underlying osteomyelitis can be evaluated first with plain films. Osteomyelitis can also suggested by positive bone scan findings. A negative bone scan finding generally excludes osteomyelitis. However, patients with an open wound such as a pressure sore can often have a falsely positive bone scan. A positive bone scan finding can be evaluated further with an MRI or bone biopsy.

Diagnostic Procedures

  • Bone biopsy is the criterion standard for the diagnosis of osteomyelitis within a pressure sore. Bone biopsy should be considered in patients with elevated ESR, elevated WBC, and or abnormal pelvic films suggestive of osteomyelitis.

More on Pressure Ulcers, Surgical Treatment and Principles

Overview: Pressure Ulcers, Surgical Treatment and Principles
Workup: Pressure Ulcers, Surgical Treatment and Principles
Treatment: Pressure Ulcers, Surgical Treatment and Principles
Follow-up: Pressure Ulcers, Surgical Treatment and Principles
Multimedia: Pressure Ulcers, Surgical Treatment and Principles
References
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References

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Further Reading

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Keywords

pressure ulcer, decubitus ulcer, bed sore, pressure sore, nonhealing wound, non-healing wound, wound healing complication, wound-healing complication, pressure ischemia, paraplegia, quadriplegia, spina bifida, immobilization, multiple sclerosis, MS, Marjolin ulcers, pressure sore reconstruction, flap procedures, chronic wound, pressure sore carcinoma

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Contributor Information and Disclosures

Author

Bradon J Wilhelmi, MD, Endowed Leonard Weiner, MD, Professor and Chief of Division of Plastic Surgery, Residency Program Director, University of Louisville School of Medicine
Bradon J Wilhelmi, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Hand Surgery, American Association of Clinical Anatomists, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association for Surgical Education, Plastic Surgery Research Council, and Wound Healing Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Neumeister, MD, FRCSC, FACS, Program Director, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Southern Illinois University School of Medicine
Michael Neumeister, MD, FRCSC, FACS is a member of the following medical societies: American Academy of Dermatology, American Association for Hand Surgery, American Burn Association, American Medical Association, American Society of Plastic Surgeons, Canadian Medical Association, College of Physicians and Surgeons of Alberta, College of Physicians and Surgeons of Ontario, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

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: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

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, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, 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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