Pathomechanical Ulcus Decubitus

• Long pressure
• Surface pressure
• Glide
• Friction
• Immobilizationan
 Pathophisiology
• Risk Factor
• Fever, anemia, infection, ischemic, hypoxemia,
hypotension, malnutritio, spinal cord trauma,
neurologic disease, thin, old age and high
metabolism.
• During aging, cell regeneration in the skin becomes
slower so the skin will be thin.

• The content of collagen in the changing skin causes

skin elasticity is reduced so it is susceptible to
deformation and damage.

• The declining ability of the cardiovascular system and

the incompetent arteriovenosus system leads to a
progressive decrease in skin perfusion.
• A number of diseases that cause decubitus ulcers such as DM that exhibit

peripheral cardiovascular insufficiency and decreased cardiovascular

function as in the respiratory system cause blood oxygenation rates in the

skin to decrease. Low nutrition and anemia slow down the healing process

in decubitus ulcers.

• Hipoalbuminemia that facilitates the occurrence of decubitus and

decrease healing dekubitus, on the contrary if there is dekubitus will cause

blood albumin levels decreased.

• In malnourished people, decubitus ulcers are more easily formed than

normal people.
 Classification
Grade 1 Grade 2
Grade 3 Grade 4
 Diagnostic
• Culture and urine analysis
• This culture is needed in incontinence to see if there are
kidney or urinary tract problems, especially in spinal cord
trauma.
• Fecal Culture
• This examination is necessary in the presence of incontinent
alvi to see Clostridium difficile leucocytes and toxins when
pseudomembranous colitis occurs.
• Biopsy
• An important biopsy on a wound state that does not improve
with intensive treatment or in a chronic decubitus ulcer to see
if there is a process leading to malignancy. In addition, biopsy
aims to look at the types of bacteria that infect decubitus
ulcers.
• Blood Investigation
• To see the inflammatory reaction that occurs should be
examined white blood cells and the rate of sedimentation of
blood. Blood cultures are needed in the event of bacteremia
and sepsis.
• State of Nutrition
• Examination of the state of nutrition in patients is important
for the healing process of ulcers dekubitus. Things to check for
are albumin levels, prealbumin levels, transferrin levels, and
serum protein levels,
• Radiologist
• Radiological examination to see the presence of bone damage
due to osteomyelitis. Examination can be done with X-rays,
bone scans or MRI.
 Therapy
• Management of decubitus ulcers with nonmedicament includes dietary

regulation and medical rehabilitation.

• Giving a diet high in calories, protein, vitamins and minerals will improve

the nutritional status of decubitus ulcer patients. Increased nutritional

status of this patient will improve the patient's immune system so as to

accelerate the healing ulcer dekubitus.

• The medical rehabilitation therapies given for the healing of decubitus

ulcers are by infrared radiation, short wave diathermy.

 Therapy
• Maintain cleanness in ulcers and surrounding
areas
• Compresses, washing, rinsing, drying and
topical ingredients such as 0.9% NaCl solution,
3% H202 solution and 0.9% NaCl, plasma
solution and Burowi solution and other
antiseptic solutions.
• Lifting necrotic tissue.
• The presence of necrotic tissue in the ulcer will
inhibit the free flow of the infected material and
hence also inhibit the formation of granulation and
epithelial tissue. Therefore the removal of necrotic
tissue will accelerate the healing process of ulcers.
• Resolving infections
• It needs culture check and resistance test.
Systemic antibiotics may be given if the
patient has sepsis and cellulitis.
Cleaned several times daily with an antiseptic
solution such as a 3% H 2 O 2 solution, 1%
povidone iodine, 0.5% zinc sulfate. Ultraviolet
radiation (especially UVB) has a bactericidal
effect.
• Stimulate and help the formation of granulation and
epithelial tissue.
• To accelerate the formation of granulation and epithelial
tissue in decubitus ulcers so as to speed healing can be
given:
• Topical materials for example:
2% salicylic salicy ointment, zinc preparation (ZnO,
ZnSO4).
• Hyperbaric Oxygen; In addition to having bacteriostatic
effects on a number of bacteria, also have a proliferative
epithelial effect, increase granulation tissue and improve
vascular state
• Surgical action
• Surgical action aims to clean ulcers and accelerate
ulcer healing and closure, especially decubitus grade
III & IV ulcers and hence frequent skin tanning,
myocutaneous flap, skin graft and other
interventions on ulcers.
 Complication
• Complications often occur in stages 3 and 4,
although it can also be in superficial ulcers.
Complications that may occur include
infection (often multibacterial, either aerobic
or anerobic), involvement of bone and joint
tissue such as periostitis, osteitis,
osteomyelitis, septic arthritis, septicemia,
anemia, hypoalbuminemia, even death