[Decubitus ulcers in the elderly].
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A description of the prevention of pressure sores is only possible when the definition of pressure sores is clear. As with other disorders early identification of patients at risk is of great importance. Beside clinical experience, several systems of registration are available for early identification. Some of these systems are described in this article. Prevention is discussed by dividing activities into those aiming at diminishing pressure- and shear forces and those improving patient's general condition. Finally, the first symptoms of pressure sores and the significance of primary, secondary and tertiary prevention are mentioned.
Grading and staging of ulcerations are defined using objective criteria. This allows for the initiation of specific therapies at various times. In addition, essential preoperative examinations are mentioned. The operative techniques, principles, and post-operative care are discussed. In a period of four years time the authors operated on 39 cases with presacral pressure sores. Complications are presented and discussed. Finally, in addition to the precautions required to prevent pressure sores, measures to limit their recurrence are mentioned.
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In spite of prophylactic treatment pressure sores in para- and tetraplegics often occur. The pressure ulcers are mostly found in certain places. Surgical intervention will be eventually necessary in most cases. Surgery should include the radical excision of the ulcer, the removal of prominent bone areas and the closure of the defect. In order to avoid large scars the surgical procedure should not exceed a certain extent. We feel that the slide and swing method after Schrudde is the most efficacious because by means of this technique large scars and free transplants which are very sensitive postoperatively can be avoided. We report on a total of 128 patients with 169 pressure sores.
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