Pressure sore

introduction of principle of pressure sore treatment

1. Pressure sore Prepared by: Dr.mohammed abd alhussein laftah Resident of plastic and reconstructive surgery

2. Pressure sore Definition: soft tissue injury caused by unrelieved pressure over bony prominence

3. Pressure sore Staging: Stage 1: erythema persist more than 1 hr. after pressure relief. Stage 2:blister or other break in the dermis with or without infection. Stage 3:subcutaneous destruction into the muscle with or without infection. Stage 4: involvement of bone or joint with or without infection . Unstageable Full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar .

4. Pressure sore Stage I

5. Pressure sore Stage II

6. Pressure sore Stage III

7. Pressure sore Stage III

8. Pressure sore Unstagable

9. Pressure sore Unstagable

10. Pressure sore Pressure Areas

11. Pressure sore

12. Pressure sore

13. Pressure sore Incidence in hospitalized patient about 9%. Risk factors: Aging Male gender Sensory impairment Moisture Immobility Malnourishment Friction shear force.

14. Pressure sore Factor accelerate bed sore progression: Infection Inflammation Edema

15. Pressure sore Preoperative care: Nutritional status assessment Control of local and systemic infection. Pressure and spasm relief.

16. Pressure sore Surgical treatment: Debridement Ostectomy Pressure sore closure.

17. Pressure sore Ischial defects: High recurrence rate Methods: Medially based thigh flap Gluteus maximus muscle flap. Gluteu maximus myocutaneous flap V-y advancement flap Gluteal Iceland thigh flap Tensor fascia lata thigh flap Graclis flap

18. Pressure sore Sacral defect: Musculocutaneous flap Fasciocutaneous flap’ Trochanteric defect: Tensor fascia lata flap.

19. Pressure sore Postoperative care: Nutrition Medical control ( d.m . ,ht. ,spasm) Nursing care. Turn over every 2 hrs. Broad spectrum ab. Sphincter control.

20. Pressure sore Carcinoma: The most common is sequamous cell carcinoma and can compare it to carcinoma raised in burn scar: Its more aggressive Metastatic rate is higher 61% compared to 34%. Time interval of development is reduced 25 y compared to 30 y in burn related carcinoma. Wide surgical excision to clear margins is recommended prophylactic lymph node dissection is not recommended but indicated if clinically involved.