Pressure injury

The highest rate of pressure sores are seen in elderly patients with cardiovascular disease (41%) , neurological disease (27%), and orthopedic injury (15%).(Grabband Smith’s Plastic Surgery p 1084, 1997)

Soft tissue issqueezed between two hard surfaces- a bed or chair on the outside of the body and a bone on the inside - creating atissue pressure thatexceeds the vascular perfusion pressure.

* Muscle is more sensitive to pressure than skin, probably because of the higher metabolic

requirements of muscle.

* Muscle begins tonecrose after 4 hours of ischemia, whereas skin can withstand approximately 12

hours.

* The elder

* The neurological disease

• the restricted mobility

• the loss of sensation

• fecal and urinaryincontinenece

* The hospitalization

• predisposing disease

• nutrition status

• infection

* Stage 1 and 2 pressure sores are typically caused byfriction or shear components.

* Stage 3 and 4 pressure sores arepressure-time components

* Relief of pressure

* Control of infection

* Nutrition

* Control of spasticity

*Seated patientsmust lift themselves from their chairs for at least5 minutes every 30 minutes, and recumbent patientsmust be repositioned at least every 2 hours.

* Pressure-reductive devices, composing of high-density foam, gels, water , or air-filled beds

* Debridement of dead tissue

* Keep surrounding skin clean and dry

* Appropriate dressing

* Topical and systemic antibiotics

* Serum albumin > 2.0gm/dl

* Daily protein : 1.5-3.0gm/kg

* Daily caloric intake: 25-35cal/kg

*VitA&C; Zinc;Ca; Fe; Cu

* Low residual diet

* Prevent progressive osteomyelitis and sepsis

* Reduce protein loss through the wound

* Improve quality of life

* Lower hospitalized costs

* Improve patient hygiene and appearance

split inferior glutealmaximus myocutaneous flap

* Hematoma

* Infection

* Wound dehiscence

* Inadequate debridement

*Recurrence rate: 15-48%