Ischial Pressure Sores



10.1055/b-0034-97721

Ischial Pressure Sores

Neil S. Sachanandani & Thomas H. H. Tung
A 35 year paraplegic male with a right-sided ischial decubitus wound.


Description




  • Stage IV ischial pressure ulcer with exposed bone and fibrinous slough.



Work-up




  • 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.



History




  • 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.



Physical examination




  • 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.



Pertinent imaging or diagnostic studies




  • Laboratory tests: Complete blood count (CBC), complete electrolyte panel, albumin/prealbumin, hemoglobin A1C, 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.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Ischial Pressure Sores

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