PRESSURE SORES - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE -

Orthopaedic Guidance for DNB Orthopaedics,MS Orthopaedics and Mrcs exams.Cme courses for orthopaedic surgeons.Davangere notes,solved question papers.DNB Ortho,MS Ortho MRCS,Exam Guide videos and notes 9087747888


Home Top Ad

Post Top Ad

Friday 30 March 2018


Bed sores or decubitus ulcer

  • results over a bony prominence – following ischemic loss of tissue – due to extrinsic pressure
  • lack of mobility
  • lack of protective sensations – as in paralyzed individuals
  • absence of vasomotor reflex – poor muscle bulk and tone
  • metabolic abnormalities
  • poor nutrition – anemia – hypoproteinemia – delayed wound healing
  • skin atrophy
  • pressure over a bony prominence over 2 hours continuously can initiate the insult
  • skin becomes emphysematous – reversible if correct action taken
  • persistence of pressure – tissue is compressed between bony prominence and external force – ischemia results
  • required pressure – as low as two times the capillary filling pressure – 2x35 – 70mmHg
  • ischemia further progress – necrosis – tissue gets infected – liquefaction
  • muscle, s/c tissue, bone, skin : varies in resistance to external pressure
    • muscle least resistant – necrosis earlier
    • bone changes are : infection of underlying bone – reactionary bursa etc.
  • Anatomical distribution
    • Hip and buttocks : 70% (ischeal tuberosity – trochanter – sacral )
    • Rest of lower limb : 20% (malleoli – heel – patellar – pretibial - popliteal)
    • Rest of body : 10% ( occiput – forehead – nose,chin, ear – scapular – elbow – back )
Staging : National Pressure Ulcer Advisory Panel Classification
  • Stage I : Intact skin – impending ulceration – reversible
    • blanchable erythema to non blanching erythema
  • Stage II : partial thickness loss of skin – abrasion – blister – superficial ulcer
  • Stage III : full thickness loss of skin and s/c tissue
  • Stage IV : skin and s/c tissue + muscle, bone, tendon, joint capsule – osteomyelitis – sinus tracts – severe undermining ulcers
  • osteomyelitis
  • septicemia
  • internal organ injury by eroding into rectum or urethra
  • Prophylaxis
    • good nursing care – frequent position changing – avoid skin rubbing or shearing while changing position
    • air / water bed
    • skin care : ethyl alcohol – talcum powder – gentle massage to improve circulation – eliminate moisture
    • nutrition : high protein – high calorie – high vitamin diet
    • catheterisation or condom drainage to avoid soiling with urine
    • avoid fecal contamination
    • early fixation of fractures – aids mobilization – reduces pain
  • Treatment
    • Acute phase
      • control infection
      • contain the area
      • debride all necrotic tissue surgically and with H2O2
      • local wound care with saline / providone iodine
      • systemic antibiotics have NO proven role
      • all dead tissue has to be removed – no fresh slough appear – the undermining has stopped
    • Definitive
      • replace tissue loss with similar tissue
      • should be done when ulcer starts to contract
      • only dermis and epidermis loss : SSG
      • Deep ulcers (floor is formed by bone) : flap
        • flaps
          • can be : skin + s/c tissue - skin + s/c tissue+muscle – muscle+SSG
          • must have good blood supply
          • enough bulk to cover the tissue loss
          • flap donor site should be such that primarily closed or by SSG
          • Sacra bed sore
            • local bilateral

              V-Y flaps
            • rotation flaps
            • both based on gluteus maximus
          • Trochanteric bed sore
            • TFL flap – can cover areas up to 15x40cm
            • based on terminal br of lateral circumflex femoral artery

Order Books Videos Notes and study material

Orthopaedics made simple for DNB MS MRCS Support and Guidance for DNB Orthopaedics, MS Orthopaedics and Orthopaedic Surgeons. DNB Ortho MS Ortho MRCS Exam Guide Diplomate of National Board.Our site has been helping dnb ortho post graduates since a long time.It has been providing the dnb ortho theory question papers,dnb orthopedics solved question bank, davangere orthopaedic notes, sion orthopedic notes.We provide guidance to post graduates as to how to pass dnb and ms ortho exams, and aspiring orthopaedic surgeons surgical technique teaching videos and orthopaedic books and pdf.
Get updates email whatsapp 9087747888

No comments:

Post a Comment

Post Bottom Ad