Operative Debridement of Pressure Ulcers
| Autor: | Jessica Schiffman, Marjana Tomic-Canic, Alan Yan, Harold Brem, Michael S. Golinko, Anna Flattau |
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| Jazyk: | angličtina |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment macromolecular substances Risk Assessment Severity of Illness Index Surgical Flaps Article Cohort Studies Sepsis 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Negative-pressure wound therapy Severity of illness Humans Surgical Wound Infection Medicine Registries 030212 general & internal medicine Aged Aged 80 and over Pressure Ulcer Wound Healing Debridement business.industry Biopsy Needle fungi food and beverages Middle Aged Vascular surgery medicine.disease Immunohistochemistry 3. Good health Surgery Cardiac surgery Treatment Outcome Cardiothoracic surgery Female business Negative-Pressure Wound Therapy Follow-Up Studies Abdominal surgery |
| Zdroj: | World Journal of Surgery |
| ISSN: | 0364-2313 |
| DOI: | 10.1007/s00268-009-0024-4 |
| Popis: | Background Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%. Methods Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement. Results The mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm2, and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement. Conclusions Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions. |
| Databáze: | OpenAIRE |
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