Pressure Injuries (Pressure Ulcers) and Wound Care Questions & Answers

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3. Woolsey RM, McGarry JD. The cause, prevention, and treatment of pressure sores. Neurol Clin. 1991 Aug. 9(3):797-808. [QxMD MEDLINE Link].

4. Abrussezze RS. Early assessment and prevention of pressure ulcers. Lee BY, ed. Chronic Ulcers of the Skin. New York: McGraw-Hill; 1985. 1-9.

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8. Pham B, Teague L, Mahoney J, Goodman L, Paulden M, Poss J, et al. Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis. Ann Emerg Med. 2011 Nov. 58(5):468-78.e3. [QxMD MEDLINE Link].

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10. Pieper B, ed. Pressure Ulcers: Prevalence, Incidence, and Implications for the Future. Washington, DC: National Pressure Ulcer Advisory Panel; 2013.

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12. Daniel RK, Faibisoff B. Muscle coverage of pressure points--the role of myocutaneous flaps. Ann Plast Surg. 1982 Jun. 8(6):446-52. [QxMD MEDLINE Link].

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15. Gefen A. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2. Nurs Stand. 2009 Jul 22-28. 23(46):40-4. [QxMD MEDLINE Link].

16. LINDAN O, GREENWAY RM, PIAZZA JM. PRESSURE DISTRIBUTION ON THE SURFACE OF THE HUMAN BODY. I. EVALUATION IN LYING AND SITTING POSITIONS USING A "BED OF SPRINGS AND NAILS". Arch Phys Med Rehabil. 1965 May. 46:378-85. [QxMD MEDLINE Link].

17. Reuler JB, Cooney TG. The pressure sore: pathophysiology and principles of management. Ann Intern Med. 1981 May. 94(5):661-6. [QxMD MEDLINE Link].

18. Le KM, Madsen BL, Barth PW, Ksander GA, Angell JB, Vistnes LM. An in-depth look at pressure sores using monolithic silicon pressure sensors. Plast Reconstr Surg. 1984 Dec. 74(6):745-56. [QxMD MEDLINE Link].

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20. Brandeis GH, Morris JN, Nash DJ, Lipsitz LA. The epidemiology and natural history of pressure ulcers in elderly nursing home residents. JAMA. 1990 Dec 12. 264(22):2905-9. [QxMD MEDLINE Link].

21. Fogerty M, Guy J, Barbul A, Nanney LB, Abumrad NN. African Americans show increased risk for pressure ulcers: a retrospective analysis of acute care hospitals in America. Wound Repair Regen. 2009 Sep-Oct. 17(5):678-84. [QxMD MEDLINE Link].

22. Manley MT. Incidence, contributory factors and costs of pressure sores. S Afr Med J. 1978 Feb 11. 53(6):217-22. [QxMD MEDLINE Link].

23. Gerson LW. The incidence of pressure sores in active treatment hospitals. Int J Nurs Stud. 1975. 12(4):201-4. [QxMD MEDLINE Link].

24. Shannon ML, Skorga P. Pressure ulcer prevalence in two general hospitals. Decubitus. 1989 Nov. 2(4):38-43. [QxMD MEDLINE Link].

25. Meehan M. Multisite pressure ulcer prevalence survey. Decubitus. 1990 Nov. 3(4):14-7. [QxMD MEDLINE Link].

26. Bergstrom N, Demuth PJ, Braden BJ. A clinical trial of the Braden Scale for Predicting Pressure Sore Risk. Nurs Clin North Am. 1987 Jun. 22 (2):417-28. [QxMD MEDLINE Link].

27. Robnett MK. The incidence of skin breakdown in a surgical intensive care unit. J Nurs Qual Assur. 1986 Nov. 1(1):77-81. [QxMD MEDLINE Link].

28. Amlung SR, Miller WL, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care. 2001 Nov-Dec. 14 (6):297-301. [QxMD MEDLINE Link].

29. Roberts BV, Goldstone LA. A survey of pressure sores in the over sixties on two orthopaedic wards. Int J Nurs Stud. 1979. 16(4):355-64. [QxMD MEDLINE Link].

30. Versluysen M. How elderly patients with femoral fracture develop pressure sores in hospital. Br Med J (Clin Res Ed). 1986 May 17. 292(6531):1311-3. [QxMD MEDLINE Link]. [Full Text].

31. Baumgarten M, Margolis DJ, Orwig DL, Shardell MD, Hawkes WG, Langenberg P, et al. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc. 2009 May. 57(5):863-70. [QxMD MEDLINE Link]. [Full Text].

32. Reed JW. Pressure ulcers in the elderly: prevention and treatment utilizing the team approach. Md State Med J. 1981 Nov. 30(11):45-50. [QxMD MEDLINE Link].

33. Barbenel JC, Jordan MM, Nicol SM, Clark MO. Incidence of pressure-sores in the Greater Glasgow Health Board area. Lancet. 1977 Sep 10. 2(8037):548-50. [QxMD MEDLINE Link].

34. Schols JM, Heyman H, Meijer EP. Nutritional support in the treatment and prevention of pressure ulcers: an overview of studies with an arginine enriched oral nutritional supplement. J Tissue Viability. 2009 Aug. 18(3):72-9. [QxMD MEDLINE Link].

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37. Klitzman B, Kalinowski C, Glasofer SL, Rugani L. Pressure ulcers and pressure relief surfaces. Clin Plast Surg. 1998 Jul. 25(3):443-50. [QxMD MEDLINE Link].

38. Evans GR, Dufresne CR, Manson PN. Surgical correction of pressure ulcers in an urban center: is it efficacious?. Adv Wound Care. 1994 Jan. 7 (1):40-6. [QxMD MEDLINE Link].

39. Fuhrer MJ, Garber SL, Rintala DH, Clearman R, Hart KA. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil. 1993 Nov. 74(11):1172-7. [QxMD MEDLINE Link].

40. Basson MD, Burney RE. Defective wound healing in patients with paraplegia and quadriplegia. Surg Gynecol Obstet. 1982 Jul. 155(1):9-12. [QxMD MEDLINE Link].

41. Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JA. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009 Feb. 90(2):213-31. [QxMD MEDLINE Link]. [Full Text].

42. Okamoto GA, Lamers JV, Shurtleff DB. Skin breakdown in patients with myelomeningocele. Arch Phys Med Rehabil. 1983 Jan. 64(1):20-3. [QxMD MEDLINE Link].

43. Basset A, Liautaud B, Ndiaye B. Dermatology of Black Skin. Oxford: Oxford University Press; 1986.

44. Lahmann NA, Dassen T, Poehler A, Kottner J. Pressure ulcer prevalence rates from 2002 to 2008 in German long-term care facilities. Aging Clin Exp Res. 2010 Apr. 22(2):152-6. [QxMD MEDLINE Link].

45. Fogerty MD, Abumrad NN, Nanney L, Arbogast PG, Poulose B, Barbul A. Risk factors for pressure ulcers in acute care hospitals. Wound Repair Regen. 2008 Jan-Feb. 16(1):11-8. [QxMD MEDLINE Link].

46. Paletta C, Bartell T, Shehadi S. Applications of the posterior thigh flap. Ann Plast Surg. 1993 Jan. 30(1):41-7. [QxMD MEDLINE Link].

47. Howard DL, Taylor YJ. Racial and gender differences in pressure ulcer development among nursing home residents in the Southeastern United States. J Women Aging. 2009. 21(4):266-78. [QxMD MEDLINE Link].

48. Dinsdale SM. Decubitus ulcers: role of pressure and friction in causation. Arch Phys Med Rehabil. 1974 Apr. 55(4):147-52. [QxMD MEDLINE Link].

49. Allman RM. Pressure ulcers among the elderly. N Engl J Med. 1989 Mar 30. 320(13):850-3. [QxMD MEDLINE Link].

50. Allman RM, Walker JM, Hart MK, Laprade CA, Noel LB, Smith CR. Air-fluidized beds or conventional therapy for pressure sores. A randomized trial. Ann Intern Med. 1987 Nov. 107(5):641-8. [QxMD MEDLINE Link].

51. Maklebust J. Pressure ulcers: etiology and prevention. Nurs Clin North Am. 1987 Jun. 22(2):359-77. [QxMD MEDLINE Link].

52. Doughty D. The process of wound healing: a nursing perspective. Prog Develop Ostomy Wound Care. 1990. 2:3-12.

53. Vaziri ND, Cesarior T, Mootoo K, Zeien L, Gordon S, Byrne C. Bacterial infections in patients with chronic renal failure: occurrence with spinal cord injury. Arch Intern Med. 1982 Jul. 142(7):1273-6. [QxMD MEDLINE Link].

54. Peromet M, Labbe M, Yourassowsky E, Schoutens E. Anaerobic bacteria isolated from decubitus ulcers. Infection. 1973. 1(4):205-7. [QxMD MEDLINE Link].

55. Deloach ED, Christy RS, Ruf LE, et al. Osteomyelitis underlying severe pressure sores. Contemp Surg. 1992. 40:25-32.

56. Deloach ED, DiBenedetto RJ, Womble L, Gilley JD. The treatment of osteomyelitis underlying pressure ulcers. Decubitus. 1992 Nov. 5(6):32-41. [QxMD MEDLINE Link].

57. Yarkony GM. Pressure ulcers: a review. Arch Phys Med Rehabil. 1994 Aug. 75(8):908-17. [QxMD MEDLINE Link].

58. Relander M, Palmer B. Recurrence of surgically treated pressure sores. Scand J Plast Reconstr Surg Hand Surg. 1988. 22(1):89-92. [QxMD MEDLINE Link].

59. Stausberg J, Kiefer E. Classification of pressure ulcers: a systematic literature review. Stud Health Technol Inform. 2009. 146:511-5. [QxMD MEDLINE Link].

60. Black J, Baharestani M, Cuddigan J, Dorner B, Edsberg L, Langemo D, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatol Nurs. 2007 Aug. 19(4):343-9; quiz 350. [QxMD MEDLINE Link].

61. Copcu E. Marjolin's ulcer: a preventable complication of burns?. Plast Reconstr Surg. 2009 Jul. 124(1):156e-64e. [QxMD MEDLINE Link].

62. Berkwits L, Yarkony GM, Lewis V. Marjolin's ulcer complicating a pressure ulcer: case report and literature review. Arch Phys Med Rehabil. 1986 Nov. 67(11):831-3. [QxMD MEDLINE Link].

63. Mustoe T, Upton J, Marcellino V, Tun CJ, Rossier AB, Hachend HJ. Carcinoma in chronic pressure sores: a fulminant disease process. Plast Reconstr Surg. 1986 Jan. 77(1):116-21. [QxMD MEDLINE Link].

64. Anthony JP, Mathes SJ, Alpert BS. The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment. Plast Reconstr Surg. 1991 Aug. 88(2):311-8. [QxMD MEDLINE Link].

65. Evans GR, Lewis VL Jr, Manson PN, Loomis M, Vander Kolk CA. Hip joint communication with pressure sore: the refractory wound and the role of Girdlestone arthroplasty. Plast Reconstr Surg. 1993 Feb. 91(2):288-94. [QxMD MEDLINE Link].

66. Lewis VL Jr, Bailey MH, Pulawski G, Kind G, Bashioum RW, Hendrix RW. The diagnosis of osteomyelitis in patients with pressure sores. Plast Reconstr Surg. 1988 Feb. 81(2):229-32. [QxMD MEDLINE Link].

67. James GA, Swogger E, Wolcott R, Pulcini Ed, Secor P, Sestrich J, et al. Biofilms in chronic wounds. Wound Repair Regen. 2008 Jan-Feb. 16(1):37-44. [QxMD MEDLINE Link].

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69. Schierle CF, De la Garza M, Mustoe TA, Galiano RD. Staphylococcal biofilms impair wound healing by delaying reepithelialization in a murine cutaneous wound model. Wound Repair Regen. 2009 May-Jun. 17(3):354-9. [QxMD MEDLINE Link].

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71. Knauer CJ. Management of malignant fungating breast lesions. Prog Develop Ostomy Wound Care. 1990. 2:3-11.

72. Gorecki C, Nixon J, Madill A, Firth J, Brown JM. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability. 2012 Feb. 21(1):3-12. [QxMD MEDLINE Link].

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75. Banks MD, Graves N, Bauer JD, Ash S. Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals. Eur J Clin Nutr. 2013 Jan. 67(1):42-6. [QxMD MEDLINE Link].

76. Cereda E, Gini A, Pedrolli C, Vanotti A. Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial. J Am Geriatr Soc. 2009 Aug. 57(8):1395-402. [QxMD MEDLINE Link].

77. Beeckman D, Clays E, Van Hecke A, Vanderwee K, Schoonhoven L, Verhaeghe S. A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial. Int J Nurs Stud. 2013 Apr. 50 (4):475-86. [QxMD MEDLINE Link].

78. Benbow M, Bateman S. Working towards clinical excellence Pressure ulcer prevention and management in primary and secondary care. J Wound Care. 2012 Sep. 21(9):S25-40. [QxMD MEDLINE Link].

79. Allen V, Ryan DW, Murray A. Air-fluidized beds and their ability to distribute interface pressures generated between the subject and the bed surface. Physiol Meas. 1993 Aug. 14(3):359-64. [QxMD MEDLINE Link].

80. Allen V, Ryan DW, Murray A. Potential for bed sores due to high pressures: influence of body sites, body position, and mattress design. Br J Clin Pract. 1993 Jul-Aug. 47 (4):195-7. [QxMD MEDLINE Link].

81. Maklebust JA, Mondoux L, Sieggreen M. Pressure relief characteristics of various support surfaces used in prevention and treatment of pressure ulcers. J Enterostomal Ther. 1986 May-Jun. 13 (3):85-9. [QxMD MEDLINE Link].

82. Patel UH, Jones JT, Babbs CF, Bourland JD, Graber GP. The evaluation of five specialized support surfaces by use of a pressure-sensitive mat. Decubitus. 1993 May. 6(3):28-31, 34, 36-7. [QxMD MEDLINE Link].

83. Seiler WO, Allen S, Stähelin HB. Influence of the 30 degrees laterally inclined position and the 'super-soft' 3-piece mattress on skin oxygen tension on areas of maximum pressure--implications for pressure sore prevention. Gerontology. 1986. 32 (3):158-66. [QxMD MEDLINE Link].

84. Heyneman A, Vanderwee K, Grypdonck M, Defloor T. Effectiveness of two cushions in the prevention of heel pressure ulcers. Worldviews Evid Based Nurs. 2009. 6(2):114-20. [QxMD MEDLINE Link].

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86. Reddy N, Cochran G. Phenomenological theory underlying pressure-time relationship in decubitus ulcer formation. Fed Proc. 1979. 38:1153.

87. Thompson-Bishop JY, Mottola CM. Tissue interface pressure and estimated subcutaneous pressures of 11 different pressure-reducing support surfaces. Decubitus. 1992 Mar. 5(2):42-6, 48. [QxMD MEDLINE Link].

88. McInnes E, Dumville JC, Jammali-Blasi A, Bell-Syer SE. Support surfaces for treating pressure ulcers. Cochrane Database Syst Rev. 2011 Dec 7. CD009490. [QxMD MEDLINE Link].

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Christian N Kirman, MD Division Chief of Plastic Surgery, John Muir Medical Center

Christian N Kirman, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Consuelo T Lorenzo, MD Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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: Abbott Laboratories Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Michael Neumeister, MD, FRCSC, FRCSC, FACS Chairman, Professor, Division of Plastic Surgery, Director of Hand/Microsurgery Fellowship Program, Chief of Microsurgery and Research, Institute of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine

Michael Neumeister, MD, FRCSC, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, CanadianSocietyofPlastic Surgeons, Illinois State Medical Society, Illinois State Medical Society, Ontario Medical Association, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, and Society of University Surgeons

Disclosure: Nothing to disclose.

Adrian Popescu, MD Research Fellow, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Disclosure: Nothing to disclose.

Patrick J Potter, MD, FRCP(C) Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Don R Revis Jr, MD Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

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.

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

Bradon J Wilhelmi, MD Professor and Endowed Leonard J Weiner, MD, Chair 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.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of Steve Jenkins in the Department of Physical Medicine and Rehabilitation at the University of Kentucky for his significant editorial assistance in preparing this article.

Dr Richard Salcido acknowledges that his studies cited in this article are supported by the National Heart, Lung and Blood Institute, the National Institutes of Health grant P01HL36552-07, the National Center for Medical Rehabilitation Research grant R01HD31426-01, the Paralyzed

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