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Results for “DECUBITUS ULCER”

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PubMed1986

The need for skin and muscle saving techniques in the repair of decubitus ulcers. A consecutive series of 72 patients and 100 ulcers over 5 years (1979/1984). A case report.

The authors report on a consecutive series of 72 patients during the period 1979-1984 presenting 100 important decubitus ulcers with a follow-up of at least one year. The repair of decubitus ulcers in paraplegic patients often requires a prolonged stay in hospital and multiple operations, since the lesions are frequently multiple. Local and general conditions make it imperative for the surgeon to choose a safe technique, with minimal tissue damage and above all leaving enough healthy skin and muscle for possible future repairs, especially in paraplegic patients. The various techniques are described according to the location of the decubitus ulcers. The following myocutaneous island flaps have been used: for sacral ulcers gluteus maximus flap; for ischial ulcers biceps femoris flap and for trochanteric ulcers tensor fascia lata flap. The authors insist on good long-term results with early social rehabilitation and prevention of recurrence, especially in paraplegic patients.

Adult↗
PubMedDate not supplied

Topical application of insulin in the treatment of decubitus ulcers: a pilot study.

To test the hypothesis that there will be a significantly greater increase in the rate of healing of decubitus ulcers in subjects who receive topical insulin therapy than in subjects who receive other forms of therapy, a pilot study was conducted, utilizing a two-group before and after design. Decubitus ulcers of six experimental group subjects were treated with a topical application of ten units of regular insulin twice a day for five days; eight control group subjects received one of a variety of topical therapies other than insulin. Data were collected on all subjects for a 15-day period. Although generalizations cannot be based on the results of 14 subjects, data analysis showed that insulin was a safe and effective agent in the healing of small, uncomplicated decubitus ulcers. The results appear to warrant a more extensive study of the subject.

Administration, Topical↗
PubMed1994

[Surgical treatment of a long-term decubitus ulcer].

A 64-year-old male presented with a large decubitus ulcer of the sacrum which had not healed for thirteen years in spite of various conservative treatments. His primary disease was paraplegia following spondylitis. Although he was not ambulatory, he was able to manage a wheelchair. The decubitus, which had a 8 x 13 cm dead space, was successfully closed with a single operation using two fasciocutaneous flaps. The patient was discharged two months postoperatively. The medical cost of his treatment before and after the surgery was investigated. The expense including the surgery and postoperative care until discharge was five times more than the monthly cost of the preoperative period. These findings suggest that a decubitus ulcer which does not respond to conservative treatments for more than several months should be considered for a surgical management, as long as the patient's general condition permits an operation.

Aged↗
PubMedDate not supplied

Experimental study of decubitus ulcer formation in the rabbit ear lobe.

An animal model of decubitus ulcer was created with the use of ear lobes of Japanese white rabbits. When the strength of the cyclic compressions and the duration of the cycles of compression and release are adjusted, the model successfully reproduced the four grades used to characterize decubitus ulcer. Compressions were recorded with video microscopy to continuously monitor the changes in tissue blood flow, in both the compressed and surrounding regions. This model is unique insofar as the blood-flow characteristics are clearly visible before, during, and after compression. Because long-term observation is possible in a living-body model, our study can easily be extended.

Animals↗
PubMed1979

Skin oxygen tension as a function of imposed skin pressure: implication for decubitus ulcer formation.

Pressure is a crucial factor in the formation of decubitus ulcers. To elucidate the effect of imposed skin pressure, a new cutaneous oxygen sensor was used to measure the skin oxygen tension under increasing pressure upon skin tissue at "hard sites" (bony prominences) and at "soft sites" (muscle-padded areas). At hard sites the skin oxygen tension fell rapidly under increasing pressure (y = 90.9--0.39. X; r = 0.98) from an initial value of 86.4 +/- 10.6 to 20.2 +/- 12.1 mm Hg under an imposed skin pressure load of 175 gm/cm 2. At soft sites a pressure load of 175 gm/cm 2 decreased the skin oxygen tension only from 82.9 +/- 5.8 to 71.4 +/- 10.0 mm Hg. These results may explain why hard sites (bony prominences) are preferential areas for decubitus ulcer formation.

Adolescent↗
PubMed1990

Proximal femurectomy for decubitus ulceration in the spinal cord injury patient.

The results of proximal femoral resections in nine patients were analyzed after an average four year follow-up, together with a retrospective analysis of the patients. The indication for surgery was decubitus ulceration that had failed to respond to multiple previous treatments. The decubitus ulcers were associated with septic arthritis, osteomyelitis, hip dislocation and ankylosis. All patients achieved short term healing with 50% achieving long term healing. The incidence of subsequent surgery for decubitus ulcers decreased significantly. No patient suffered a deterioration in function.

Adult↗
PubMed2005

The influence of a change in medicare reimbursement on the effectiveness of stage III or greater decubitus ulcer home health nursing care.

This study was designed to describe and evaluate the influence of a change in a Medicare reimbursement on the effectiveness of home health nursing care for stage III or greater decubitus ulcer patients. This health policy originated from the Balanced Budget Act (BBA) of 1997 and took its full effect with initiation of the Prospective Payment System (PPS) on October 1, 2000. A quantitative quasi-experimental design used OASIS data from the state of Virginia to evaluate 555 stage III or greater decubitus ulcer patients, age 65 or older. Comparisons were investigated between pre-PPS, 2000, and post-PPS, 2001, outcomes related to reported ulcer healing, lengths of stay, and discharge disposition. Results demonstrated significant differences for the outcomes studied. In addition, sanitation, ulcer healing, and discharge disposition were linked as predictors for length of stay. Results demonstrated that PPS has affected nursing care effectiveness for stage III or greater decubitus ulcer home health patients.

Aged↗
PubMed1989

Method for the measurement of susceptibility to decubitus ulcer formation.

A method for measuring the susceptibility of a patient to develop decubitus ulcers is described and initially evaluated. It is based on an indirect, noninvasive measurement of the transient regional blood flow response after a test pressure load which simulates the external stimulus for pressure-sore formation. This method was developed to determine the individual risk of a patient and to study the subfactors which contribute to the susceptibility. This would also offer the possibility of evaluating the effect of preventive treatment aimed at reducing the susceptibility. The method was found to discriminate between preselected elderly patients at risk on the one hand, and non-risk patients and healthy young adults on the other hand. No differences in blood flow responses were found between the non-risk elderly patients and the healthy young adults. This suggests that age per se is not a factor in the formation of pressure sores. In the risk group the recovery time after pressure relief was found to be three times as long as the duration of the pressure exercise. This indicates that the recovery time after pressure exercise may be as important as the period of pressure exercise in deducing the risk of developing decubitus ulcers.

Adult↗
PubMed1999

[Decubitus ulcer. Basic treatment intervention is pressure unloading].

With an incidence of between 3 and 34%, decubitus ulcers are common chronic wounds, many of which can be avoided by prophylactic measures. The most effective preventive measure is relieving pressure on the endangered part of the body, and this is most easily achieved by regularly changing the patient's position in bed. Since, however, this is not always possible for staff-shortage or illness-related (e.g. fractures of the spine) reasons, modern pressure-relieving systems are being increasingly used. The range of options extends from simple foam plastic underlays to water-filled cushions to pneumatic cushions or beds filled with tiny glass beads. Selection of the most appropriate system is often difficult. For effective prophylaxis, determination of the individual risk of developing a bedsore with the aid of special scales makes good sense. In this way, the measures required can be adapted to the particular needs of the individual patient. New approaches to decubitus ulcer prevention and wound management may help to ensure effective care of the endangered or affected patient.

Adolescent↗
PubMed1977

Clindamycin for treatment of sepsis caused by decubitus ulcers.

Bacteremia was documented in 19 (76%) of 24 patients with sepsis caused solely by decubitus ulcers, persisted in all but two, and was polymicrobial in 10 (42%). Obligate anaerobes were isolated from 12 patients (63%) and included Bacteroides fragilis in 11 (58%). Aerobes, primarily Proteus (21%) and Staphylococcus (16%), were isolated in nine patients (47%). Therapy was judged appropriate when the microbial isolates were susceptible in vitro to the antibiotic used. Nineteen patients received clindamycin plus gentamicin, which was considered appropriate for all but one patient. Four patients received cephalothin plus kanamycin, which was inappropriate for three patients. One patient received appropriate treatment with methicillin, gentamicin, and chloramphenicol. Patients who received appropriate antibiotics and had surgical intervention had the lowest mortality rate (14%); in those treated with appropriate antibiotics but without surgical intervention, the incidence of death was 67% (P less than 0.05). Patients who received inappropriate antibiotics, whether or not there was surgical intervention, had a 75% mortality rate (P less than 0.05). Surgical debridement and antibiotic therapy effective against aerobic as well as anaerobic bacteria are important factors in the treatment of sepsis caused by decubitus ulcers.

Aerobiosis↗
PubMed2003

[Treatment of decubitus ulcers in the geriatric patient].

Pressure sores (decubitus ulcers) and their treatment are a typical problem of old people in need of nursing care, after traumatization or in diseases of the peripheral nervous system. Patient instruction and appropriate schooling of nursing staff with regard to risk factors, and the use of standardized risk assessment aids, such as the Norton scale, can improve risk identification and prophylaxis, and minimize recurrent ulcers. Patients put at particular risk by paralysis, cachexia, shock, disturbed arterial perfusion, anemia, dehydration or major surgery should be bedded appropriately. In addition to the development of numerous modern wound dressings, the introduction of continuous vacuum therapy (V.A.C.) is of proven value, both as sole treatment resulting in healing and for accelerated preparation for plastic surgery. In stage 3 and 4 ulcers, plastic surgery involving displacement of tissue are usually required for permanent treatment.

Age Factors↗
PubMed1988

Decubitus ulcers: update on new approaches to treatment.

Decubitus ulcers are best treated by eliminating the primary etiology, pressure, while supplementing care with the best available treatment modality. Knowledge of new treatment modalities and appropriate selection will help expedite wound closure. Pressure-relieving devices should not be relied upon to eliminate all pressure from the wound. Pressure relief should be supplemented with choice of appropriate dressings and additional therapy. The use of electrical stimulation, biomaterials, and growth factors may soon become available as additional modalities to expedite closure and facilitate wound repair.

Bandages↗