‫ﺷﺮح ﻋﻠﻰ ﻣﺤﺎﺿﺮة ﺗﺨﺘﻠﻒ ﺷﻮﯾﮫ‬

Pressure Ulcers ‫ ﻣﮭﻤﻤﻢ‬preoperative care‫ال‬

Kadhum Jawad Shabaa MBChB, FICMS

(.Prof. Consultant plastic surgeon)
Head of plastic surgery department in Alsader
Teaching Hospital-Najaf
 ‫بسم هللا الرحمن الرحيم‬
‫(وتحسبهم ايقاظا وهم رقود ونقلبهم ذات اليمين و ذات الشمال‬
‫وكلبهم باسط ذراعيه بالوصيد لو اطلعت عليهم لوليت منهم‬
‫فرارا ولملئت منهم رعبا‬
‫)‬
‫صدق هللا العلي العظيم‬
‫الكهف ‪18‬‬
 Movie star and stem cell research advocate
Christopher Reeve
Died in 2004
from complications of

Egyptian mummies
5,000 years ago
 Pressure sores
The terms pressure sore, decubitus ulcer, and bedsore
have been used to refer to the tissue ulceration
commonly seen in debilitated patients.
The term decubitus comes from the Latin word
decumbere, which means to “to lie down.” Although
this term may be appropriate for patients who are
bedridden, it does not correctly describe the ulcers in
patients who are mobile (i.e., ischial ulcers in
wheelchair-bound patients).
‫الكرسي املتحرك‬
Normal pressure 20-25 mmhg
Fan shape Pressure from two site
ulcer
Bone from inside
And object from outside
 Pressue Sores

Non-decubitus Decubitus

Bed sores

Decubitus = decumbere = “to lie down”

In prone position ..!! In lateral position

In supine position
Knee in prone Sacrum more in prone

Pressure
 Epidemiology
In general, approximately 9% of all hospitalized
patients develop pressure sores. The occurrence
seen in the acute care setting is as high as 11%.
Commonly cited in all studies was their
association with other medical problems,
including cardiovascular disease (41%), acute
neurologic disease (27%), and orthopedic injury
(15%).
Alsader Teaching Hospital

10% will have pressure ulcer

So need to treat them before
they develop complication
 Blister and may infection

Just Redness

Ulcer develop and extended to Involvement of bone

subcutaneous tissue
17
 TABLE 1. Pressure sore staging

Stage Description
Stage I Skin intact but reddened for more
than1 hour after relief of pressure
Stage II Blister or other break in dermis ±
infection
Stage III Subcutaneous destruction into muscle
± infection
Stage IV Involvement of bone or joint ±
infection

Stage V if it involve the lumen like the GIT ..!!!

Bxz high percentage
to recurrence
 Assess and record risk

Risk factors include:

• pressure • comorbidity
• shearing • posture
• friction • cognition, psychological status
• level of mobility • previous pressure damage
• sensory impairment • extremes of age
• continence • nutrition and hydration status
• level of consciousness • moisture to the skin
• acute, chronic and terminal
illness

Reassess on an ongoing basis

13
 Conservative treatment
• Change position 15 minutes for wheel chair ,2
hours for bedridden
• Using support surfaces
• Hydrocolliod dressing.
• Comfeel Ulcer dressing

• Supragel
Pure honey is strong hypertonic liquid

• Honey Absorb fluid then lead to shrinkage of the micro organism

that pulls much of the bacterial water
and then shrinkage and death occurs

• Nutritional support
 Preoperative care
1. Nutrition.
2. Infection.
3. Releive of pressure mattress systems are designed to relieve
pressure, including foam, static flotation, alternating air, low-
air-loss, and air fluidized beds. The purpose of these beds is to
more evenly distribute the patient’s weight to minimize
pressure in any one area. The Clinitron bed is designed with
medical-grade optical beads fluidized with a constant flow of
warm air.
4. spasm valium baclofen dantrolene rhizotomy
5. Contacture Rhizotomy is a surgical procedure to sever nerve
Like bitox toxin
roots in the spinal cord. The procedure effectively
relieves chronic back pain and muscle spasms.
For spinal joint pain, a facet rhizotomy may
provide lasting low back pain relief by disabling
the sensory nerve at the facet joint.
Bxz most of them they have mal absorption or manurishing
 Surgical Rx
1. Debridment Excision of the necrotic tissue .. to cut the viscous cycle ..!,
2. ostectomy By removing the prominent part of the bone that act on ulcer
3. closure Closure is the responsible of the plastic surgery
Regional anatomy
 Muscle falp
Myocutqnous flap Rotational flap

Closure is the responsible of the plastic surgery

Rotational flap

Recuurence
Common used
Posterior thigh Falp
Rotational flap
From lateral to medial to cover ischial area
Suction Dressing
Both general and local control were done by
treating anemia, malnutrition ,UTI,
hyperglycemia . Wound swab was routinely
taken to determine the bacterial growth and
appropriate antibiotics were given accordingly.
 TFL flap
Tensor Fascia Lata (TFL)

trochanteric pressure ulcer

 Rotational flaps

Ischial ulcer
 Conclusions and
recommendations
• We found that simple rotation flap is useful and
effective way of managing sacral sores while Tensor
Fascia Lata flap is very beneficial in trochanteric sores.
• A team work planning is recommended to deal with
such difficult cases .Nursing homes showed significant
improvement in the quality of pressure ulcer preventive
care .
• Further studies are required to evaluate the significant
difference between different local antimicrobial agents ,
use of VAC system , and free flap surgery in the
management of pressure sores.
Thank you