The etiology, prevention and management of decubitus ulcers.
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Twenty-five patients with 35 bedsores were treated with dextranomer (Debrisan; Adcock Ingram) applied topically to the ulcers. Fourteen patients had ulcers which penetrated fascia, muscle and bone, 4 had superficial ulcers and 2 had discharging sinuses. Most of the severe ulcers healed rapidly and were cleansed and ready for surgery at an average of 14.6 days. The superficial ulcers were completely healed within 3 weeks. Treatment of the sinuses with dextranomer using a catheter/syringe technique resulted in wound closure within 28 days. In a representative sample of 12 patients in whom the surface area of the ulcers was measured by means of a planimeter, there was a median reduction in surface area of 44.8% by the 2nd week (P=0,0002) and 79% (P=0,001) at the end of the 4th week. The median percentage reduction in depth was 66.7% (P=0,008) at the end of the 4th week.
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Placing female patients in prone position with widely spread legs provides very good exposure of the anterior vaginal wall and makes it possible to use the vaginal route alone for the surgical treatment of lower urinary tract lesions, such as vesico-vaginal fistulas.