Pressure sores are wounds that result from ischemic tissue loss due to pressure against a bone prominence. With the best of care, pressure sores are preventable. However, despite the best of efforts, pressure sore recurrence rates in patients with spinal cord injuries exceed 50% during the long term.The single most important factor in the development of pressure sores is excessive and prolonged pressure. If external pressure is greater than end-capillary bed pressure (32 mm Hg), tissue perfusion will be impaired and ischemia will result. Although extreme changes in the overall nutritional status of an individual can play a role in the formation of pressure sores, a healthy nutritional state alone does not protect against the development of a pressure wound. Decreased serum protein level, anemia, and vitamin deficiencies are markers that should be further evaluated if a patient’s nutritional status is in question. In general topical hygiene is of paramount importance.The skin should be kept clean and dry. It should be washed and dried immediately after any bowel movement or occurrence of urinary incontinence.
If however a pressure sore occurs conservative treatment with frequent position changes and wound dressing care are tried first. In case of no improvement wide surgical debridement of all devitalised tissue and bony prominence-bursa is need. Flap reconstruction provides a good coverage.The flap used for coverage should be designed as large as possible, with placement of the suture line away from the area of direct pressure; to preserve all future options for coverage, the flap design should not violate adjacent flap territory. Perforator flaps are preferred as they do not burn any bridges but in deep cavities musculocutaneous flaps are used as well. Dr. Spyriounis has extensive experience in pressure sore surgical treatment.
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