Ischial Pressure Sores

10.1055/b-0034-97721

Neil S. Sachanandani & Thomas H. H. Tung

Clean, pink granulation tissue at wound base with no evidence of gross contamination.
Multiple scars indicative of prior surgical management with likely posterior thigh and gluteal rotation flaps.

Risk factor assessment: Age, nutritional status, comorbid conditions (diabetes, vascular disease), ambulatory status, spinal cord injury, spasm and previous treatment, continence (urine and fecal), tobacco and substance abuse, presence of shear forces, mental status
Support network
- For treatment and continued care.
- Home environment and any pressure-reducing devices.
Current wound and skin care regimens.
Previous wounds and interventions.
History of current wound: Duration, previous infection, changes in size.

Location and dimensions of wound, quality of surrounding tissues, focused sensory examination.
Presence of spasm, moisture, soilage.
Evidence of infection.

Pressure ulcer staging (Table 31.1).

Pressure ulcer staging
Stage	Findings
I	Intact skin with nonblanching erythema, usually over a bony prominence.
II	Partial-thickness dermal loss. Appears as a shallow open ulcer with a red–pink wound bed without slough, or as a serum-filled bullous lesion (intact or ruptured).
III	Full-thickness tissue loss. Subcutaneous fat may be visible. Bone, tendon, or muscle is not exposed; these are prefascial wounds. May have undermining.
IV	Full-thickness tissue loss through the fascia with exposed bone, tendon, or muscle. Often includes undermining and tunneling.

Laboratory tests: Complete blood count (CBC), complete electrolyte panel, albumin/prealbumin, hemoglobin A_1C, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP).
Magnetic resonance (MR) imaging: Osteomyelitis is suggested by the presence of T2 hyperintensity and low intensity on T1 images; sensitive and specific for osteomyelitis.
Tissue biopsy: For pathology in chronic wounds and for culture.
- Bone biopsy may be useful to rule out osteomyelitis, especially if suggested on MR imaging.