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PubMed1996

[Decubitus ulcer in the calcaneus region: rapid development, difficult recovery].

Heel pressure sores frequently arise in patients kept in bed for a long time independently of their primary disease. In account of this event the authors completed a study concerning possible mutual relations between heel pressure sores and primary disease of the patients; to validate the pharmacological treatment in less severe sores and the surgical resolution in more serious cutaneous lesions. In the last 3 years (1992-1995) at the Rehabilitation Centre of Montescano the authors have treated 39 patients suffering from 63 different severe cutaneous lesions: from phlycten to deep necrosis. The therapeutic plane utilized pharmacological treatment for 1st, 2nd, 3rd degree pressure sores, and surgical treatment for 4th degree. Pharmacological treatment included: enzymatic drugs, bactericidal and bacteriostatic medicines and cicatrizing substances. Different healing times were related to different pressure sore severity. Surgical treatment consisted of transposition of flap into wound defect. This system caused considerable reduction in resolution times. The authors noticed how easily pressure sores arise in the heel region, and how difficultly they heal. This is probably connected with particular anatomical and vascular characteristics of this region.

Heel↗
PubMedDate not supplied

[Decubitus ulcers in intensive care units. Analysis and care].

The fact that intensive care patients suffer from ulcera is a daily evidence which has a negative repercussion. We have analysed prospectively a sample of 215 patients to know the incidence, prevalence, levels, and placement of the decubit ulceras to observe whether there is an association between the variables age, sex, staying end, diagnosis, diabetes, risk level and postural changes and ulceration incidence. To do so, we have created a nursing care protocol for decubit ulceras to unify criteria and norm the performances. One out of every five I.C.U. patients suffers from ulcera and 30% of them show four or more ulceras, being the sacro and the heels the most usual places. There is an association between the patient's age, number of days staying in I.C.U. and diabetes and a higher incidence of ulceration. On the other hand, patients with politraumatisms diagnosis, infections and respiratory pathologies suffer from ulcera more than others. There is a clear association between the time of staying without postural changes and the incidence of ulceration. The same thing happens with the high risk stay. Our population is over 61% of I.C.U. stay in high risk, and its incidence of ulceration is 21%. Comparing both parametres we obtain an idea of the prevention which nursing professionals perform.

Female↗
PubMedDate not supplied

[The treatment of decubitus lesions].

The authors present a plan for pharmacological treatment of pressure sores in patients affected by neurological pathologies: cerebrovascular accidents, head injuries, spinal cord injuries. This plan is easily applicable to all pressure sores included between first and third degree of the Reuler and Cooney classification. Authors identified some drugs specifically usefull in different cutaneous lesion degrees. Skin lesions and employed medicines are described as follows: Erythema: semi occlusive bandage with porous adsorbing membrane. This dressing must be left in for five days at least. Excoriation: bactericidal or bacteriostatic medicines if it's situated in a non pressed area while the same dressing utilized for erythema if it's localized in a pressed area. Pressure sores: if there is local infection cleanse the wound from bacterial defilement using topic antibiotics apply compresses with vitamin C if the cutaneous lesion is larger than deeper, Cadexomero lodico if it's deeper than larger. Fistulas: wadding with tablets of collagen. Necrobiosis: complete or partial surgical removal of eschar preceded by the use of enzymatic drugs when eschar is firmly adherent to subcutaneous tissues. The first group collects 9 patients with stroke and head injury: 8 with sacral and 1 with heel pressure sores. First degree pressure sores heal within 45 days and third degree lesions within 160 days. The second group collects 10 spinal cord injury patients mostly with complete lesion among which: 7 sacral, 1 heel, 1 ischiatic and 1 malleolar lesions. First degree pressure sores heal within 30 days, third degree pressure sores heal within 200 days. Healing time are considered acceptable. Pressure sores recovery swiftness can be related to different factors such as pressure sores sterness, neurological pathology and arising of clinical complication (hyperthermia, infections, low serum albumin values, etc).

Adult↗