[Diabetic ulcer--diabetic feet. Report from the congress: "Decubitus ulcers. A problem for doctors and nurses" Orbassano,Torino, November 6, 1988].
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Diabetic Angiopathies↗
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Pressure (decubitus) ulcer: variation in histopathology--a light and electron microscope study.
The histopathology of pressure (decubitus) ulcers from 20 patients was examined by light and electron microscopy. Surgical biopsy specimens from the ulcer edge, ulcer margin, and adjacent normal, nonulcerated skin showed four general types of ulcer histopathology. Morphological features common to all ulcer groups were a dense fibrin matrix, occluded blood vessels, numerous inflammatory cells, and a range of cellular viability from functionally normal appearing cells to cells in all stages of necrosis. These data present structural reference points for comparing pressure ulcer pathology and evaluating the effects of growth factors on wound healing.
Humans↗
[How to evaluate nursing procedures for bedsores, or decubitus ulcers by means of a codified and computerized record-keeping system].
Bedsores, or decubitus ulcers, are a very serious health problem in our society which has more elderly people all the time. Clinical files, whether they record preventive care or actual treatment and follow-up analysis of results, are a challenge for nursing practice. Therefore, the authors developed a simple, easy to use and fill out document: a "File to record the evolution, care and treatment of bedsores". Treatment methods are recorded by means of previously designated numerical codes corresponding to the treatment methods carried out which enables their subsequent computerization and makes it possible to analyze them. The results obtained permit nursing professionals to analyze work tasks assigned, treatment quality and the efficiency of procedures and products used: furthermore, this file enables nurses to elaborate a description of an elderly patient having multiple pathologies, a target for these lesions, and to establish a nursing treatment procedure especially adapted to the required treatment.
Cross-Sectional Studies↗
[Decubitus ulcers: evaluation of a protocol].
An evaluation of the incidence, treatment and prevention of decubitus ulcers is presented within the framework of an Internal Medicine unit. Chosen for the study from a pool of admitted hospital patients were 60 people believed to be at risk of ulceration. They were evaluated according to established criteria and they were then followed during the length of their stay. Of these 60 patients, 38 later developed lesions. Of these 38, 63.2% were admitted with ulcers and 36.8% developed their pressure sores while in the hospital. 65.3% of those ulcers healed completely during the patients stay; 7.6% actually got worse. A significant statistical risk between the appearance of ulcers and the evaluated at risk factors was not found.
Aged↗
The relationship between extended periods of immobility and decubitus ulcer formation in the acutely spinal cord-injured individual.
Several variables may influence the development of decubitus ulcers during the acute treatment phase following spinal cord injury. Three independent variables were studied: level of injury, completeness of injury and length of time immobilized. Of these, length of immobilization exceeding 6 hours was associated with subsequent development of a sacral or occipital decubitus at a statistically significant level (p = .0094). The presence of a complete injury was associated with decubitus formation at a noticeable but statistically insignificant level (p = .0759). Cervical injuries were not associated with an increased rate of decubitus formation. Results suggested that initial treatment of acute spinal cord injuries should include the use of pressure relieving maneuvers or devices as soon as possible, especially in patients with anticipated extensive immobilization. Recognizing that risk of decubitus formation increases with immobilization time, the period of time involved in initial diagnosis and intervention should be kept to a minimum. This is particularly true in patients with complete spinal cord injuries.
Adolescent↗
Secondary hemophagocytic syndrome in a patient with methicillin-sensitive Staphylococcus Aureus bacteremia due to severe decubitus ulcer.
A 51-year-old man with poliomyelitis was admitted to emergency because of a severe decubitus ulcer on his right hip that was associated with infection. His general condition deteriorated and he was malnourished and dehydrated. Despite adequate hyperalimentation and antibiotic administration, laboratory data indicated pancytopenia 4 days later. He was diagnosed as having secondary hemophagocytosis (HPS) associated with methicillin-sensitive Staphylococcus aureus sepsis due to decubitus inflammation based on bone marrow aspiration and a blood culture. Although granulocyte colony stimulating factor, packed red blood cell transfusions, platelet transfusions, and antibiotics gradually improved the pancytopenia, the patient died of massive gastrointestinal tract bleeding.
Bacteremia↗
The management of decubitus ulcers by muscle transposition. An 8-year review.
Our 8-year experience with the management of decubitus ulcers by means of muscle transposition and skin cover is reviewed. The role of infection and its management are discussed. Some modifications of our previous techniques and newer operative approaches are detailed. Our complications and follow-up results are presented.
Bacterial Infections↗
The care of decubitus ulcers pressure sores.
Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions. and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.
Administration, Topical↗
[A guide to prevent decubitus ulcers in bedridden patients].
The authors present a report they produced dealing with how to prevent decubitus ulcers in bedridden patients. This report, designed in a practical use format, can be easily understood by all those nursing care professionals who have to care for bedridden patients; it is a highly useful tool for the nursing field.
Humans↗
Penetration of clindamycin into decubitus ulcers.
Forty tissue samples, primarily of skin and bone, were obtained from 29 patients undergoing excision of decubitus ulcers after intravenous injection of 600 mg of clindamycin. Antibiotic concentrations exceeded 2.5 mug/g in 80% of the samples. In 50% of the instances, tissue levels were greater than those simultaneously present in the serum.
Adolescent↗
A gluteus maximus myocutaneous island flap for the repair of a sacral decubitus ulcer.
The gluteus maximus myocutaneous island flap is a useful, safe and versatile flap for the repair of sacral decubitus ulcers. It is now our recommended procedure of choice for the surgical treatment of this type of wound (Maruyama and Tajima, 1978).
Adult↗
Primary closure of trochanteric decubitus ulcers: the bipedicle tensor fascia lata musculocutaneous flap.
A surgical procedure is described for the definitive treatment of trochanteric decubitus ulcers. It combines the advantages of the bipedicle skin flap and the musculocutaneous flap; that is, a large area of skin is provided with a thick protective padding consisting of fat, fascia, and muscle richly vascularized by the musculocutaneous perforating circulation. The disadvantages of either flap alone (i.e., dependence on dermal blood supply and skin grafting of the donor bed) are avoided. In patients who are traditionally the most difficult nursing problems, this one-stage reconstructive procedure results in shorter operating room time, easier postoperative care, shorter hospital convalescence, and an enduring protection against recurrent trochanteric pressure problems.
Fascia↗
Phenytoin-induced lymphocytic chemotaxis, angiogenesis and accelerated healing of decubitus ulcer in a patient with stroke.
We studied the effect of topically applied phenytoin on the healing of a decubitus ulcer in the sacral region of an immobile patient with stroke. Another similar, but smaller, ulcer was treated with conventional treatment only and served as a control. The ulcers were measured once a week and biopsies were taken from the margins before, 1 week and 2 weeks after commencing treatment with phenytoin. Clinically, phenytoin substantially accelerated the rate of healing. Microscopic examination of the biopsies showed increased lymphocytic infiltration of the phenytoin-treated lesion. Anti-CD31 immunohistochemistry revealed dense CD31+ lymphocytic infiltration and increased angiogenesis only in the phenytoin-treated lesion. Our findings suggest that phenytoin enhances wound healing by stimulating lymphocytic chemotaxis and up-regulation of angiogenesis.
Chemotaxis, Leukocyte↗
[Myocutaneous flap from the tensor fasciae latae in treatment of trochanteric decubitus ulcers].
The paper presents paraplegic patient after L1-L9 subluxation due to the spine injury. Excision of trochanteric decubitus ulcer covered with the tensor fasciae latae myocutaneous flap gave permanent result.
Back↗
[Treatment of suppurative-necrotic decubitus ulcers in patients with spinal injuries by using alginate coating teralgim and algimaf].
Alginate coating teralgim and algimaf were applied to 24 decubitus ulcers of various sites in 19 spinal patients. Stage--specific choice of applications produced a good cleansing effect and ulcer healing in 62.5% of the lesions within 48.5 days on the average. Indications for surgery were defined in 37.5% of the cases (repair of the ulcer defect) which were also treated with alginate coating with a good preoperative effect.
Adult↗
New perspectives in the treatment of decubitus ulcers.
Although the consequences of prolonged lying on a hard surface are as old as the human race, publications on this subject are scarce. This is due to the fact that a decubitus ulcer never occurs in isolation but is nearly always a complication of some other condition. The term "decubitus" was already used by Hildnaus in 1590 and is derived from the Latin word decumbere which means "lying down". The most important fact to keep in mind is that pressure sores can be prevented. This is the reason why this article not only discusses the management of pressure sores but also the importance of preventive measures. The basis of effective treatment is early detection and an adequate knowledge of the fundamental pathological process. Only adequate preventive measures, careful examination of the lesions, and a thorough knowledge of the products used can avoid unnecessary suffering by patients.
Aged↗
[Consciousness disturbance caused by iodoform absorption in a patient with decubitus ulcer topically treated with iodoform-gauze].
A 76-year-old man with supranuclear palsy, developed consciousness disturbance followed by the treatment of decubitus ulcer in the sacral region using iodoform-gauze. He was semicoma and tachycardia. His pupils were miotic and light reflexes were absent. EEG demonstrated diffuse and random slow activities. Plasma concentration of free iodine was high (151 micrograms/dl), but the other laboratory findings including thyroid functions were normal. He was diagnosed as suffering from iodoform poisoning. The symptoms and laboratory abnormalities of the patient recovered soon after the removal of iodoform-gauze. Although iodoform has been widely used for the treatment of wounds, there are few case reports of its side effects, such as consciousness disturbance, delirium, headache and tachycardia.
Acute Disease↗
Susceptibility to decubitus ulcer formation.
The hypothesis of blood-flow recovery time after pressure relief was prospectively evaluated as a measure of a patient's susceptibility to develop decubitus ulcers. This blood-flow recovery time was measured using the noninvasive pressure-temperature-time (PTT) method, which uses a 10-minute test-pressure stimulus. The blood-flow response after pressure relief was measured by means of skin-temperature measurements. The evaluation was performed in a group of 109 elderly nursing home patients. A pressure-index was used as a measure for the intensity and duration of pressure and shear forces, to which a patient was exposed, to measure a set of external determinants that are independent of the susceptibility. Both the blood-flow recovery time and the pressure-index were found to correlate significantly with the risk to develop decubitus. A conceptualization of the relationship between the risk, on the one hand, and the susceptibility and the external determinants, on the other hand, is presented, assuming independence (orthogonality) of both sets of determinants. Based on this conceptualization, a three-dimensional risk-relationship was constructed. It is concluded that the blood-flow recovery time can be considered to be a measure for the susceptibility. Further, the conceptualization provides valuable insight into the risk-relationships and forms a base for future research with regard to susceptibility.
Activities of Daily Living↗