1/156. Necrotizing fasciitis: an uncommon consequence of pressure ulceration.Pressure ulcers may occur in patients with chronic illnesses, especially in those who are bed-bound or chair-bound. Local measures usually suffice to allow primary ulcer healing and support skin grafting or tissue transfer reconstruction. On rare occasions, however, pressure ulcers may progress to invasive infection and necrosis of adjacent soft tissues, possibly leading to necrotizing fasciitis. Early recognition and aggressive medical and surgical therapy are required to halt disease progression and prevent patient mortality. Two cases are presented to describe the severity of this soft-tissue infection.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
2/156. skin care of the pediatric patient.Several factors influence the chronically ill child's susceptibility for skin breakdown. nurses are an integral part of the care team that has the responsibility for identification of these factors, as well as pressure ulcer prevention and early intervention. An important aspect of this responsibility is identification of individuals at risk. This article provides a guide for assessment and early intervention for skin breakdown in chronically ill children. A care plan and consultation recommendations are included.- - - - - - - - - - ranking = 0.14285714285714keywords = ulcer (Clic here for more details about this article) |
3/156. The efficacy of single-stage surgical management of multiple pressure sores in spinal cord-injured patients.The practice of multiple-stage management in the treatment of patients with multiple pressure ulcers has long represented the standard of care in many specialty centers. The authors have observed that an aggressive surgical approach has proved necessary for control of this devastating problem in these patients. Their experience with one-stage reconstruction of multiple pressure sores over a 10-year period (between 1986 and 1996) in 120 spinal cord-injured patients has revealed certain advantages of this comprehensive method of surgical management. Although cumulative operating time and intraoperative blood loss were somewhat increased, the number of anesthetic episodes and the hospital stay were less than that seen in patients managed in multiple stages. Accordingly, rehabilitation and societal reintegration can be initiated earlier, and overall hospital cost may be better contained.- - - - - - - - - - ranking = 0.14285714285714keywords = ulcer (Clic here for more details about this article) |
4/156. Treating stage IV pressure ulcers with negative pressure therapy: a case report.Decubitus ulcers remain a significant healthcare concern today, especially in the elderly and immobile population. Following the observation of three Stage IV decubitus ulcers refractory to standard medical and surgical therapy for 10 months, a new vacuum-assisted closure device (V.A.C.) was initiated to speed wound healing. The V.A.C. was initiated in August 1996. The three Stage IV ulcers were located on the patient's right ischium, left ischium, and sacrum. On initiation, they measured 7 1/2 cm x 2 1/2 cm x 2 1/2 cm, 8 cm x 3 1/2 cm x 2 1/2 cm, and 3 1/2 cm x 2 cm x 2 cm respectively. The treatment consisted of insertion of sterile sponge into the wound bed connected to the negative pressure device by suction hose. The device operated at a negative pressure of 125 mm Hg with a 5-minute-on 2-minute-off-cycle. Dressing changes were performed every 48 hours during the treatment period. Successful closure of the sacral ulcer occurred in October 1996. The ischial ulcers were small enough to be taken off V.A.C. therapy in early November 1996. While we are encouraged by the results of this study, further additional clinical studies are warranted.- - - - - - - - - - ranking = 1.2857142857143keywords = ulcer (Clic here for more details about this article) |
5/156. The ethics of using contingency management to reduce pressure ulcers: data from an exploratory study.Although there is a widely held argument that pressure ulcers are preventable, they continue to cause major healthcare and financial problems. The blame for pressure ulcers has typically focused on the patient's self-neglect or self-destructiveness. However, more recently, there has been a call for a paradigm shift from the current "paternalistic" medical model to one that includes the patient as a participant in his or her own care. Contingency management, a procedure well known in behaviorism, is presented as one such possibility. Controversy about the use of monetary reward, as well as discussion of initial efficacy in a current study, are discussed.- - - - - - - - - - ranking = 0.85714285714286keywords = ulcer (Clic here for more details about this article) |
6/156. paraplegia: prolonged standing using closed-loop functional electrical stimulation and Andrews ankle-foot orthosis.One T10 paraplegic male (CS) implanted in 1991 with a Nucleus FES-22 stimulator has been able to achieve closed-loop standing for 1 h. The knee angles are monitored by electrogoniometers, resulting in the quadriceps stimulation time being less than 10%. Stance stability is achieved by the Andrews anterior ankle-foot orthosis (AFO). The use of accelerometers for trunk inclination and vertical acceleration during controlled stand-to-sit, diminishes slamming onto the seat. CS does one-handed tasks with objects of 2.2 kg. In another T10 paraplegic male (FR), surface stimulation was applied over 1.5 years to both femoral nerves at the groin for conditioning and prolonged standing. With quadricep conditioning, 55 Nm at 45 degrees of knee flexion is produced. With the AFO and knee monitoring, FR can stand uninterrupted for up to 70 min and perform one-handed tasks. In August 1998, he was implanted with the multifunctional Praxis FES 24-A stimulator for restoration of limb movements, bladder and bowel function, and pressure sore prevention.- - - - - - - - - - ranking = 0.00043187953672372keywords = foot (Clic here for more details about this article) |
7/156. Anterior flap for coverage following hip disarticulation for osteomyelitis.The use of a posterior myocutaneous flap is the most common method of coverage following hip disarticulation. Other options for coverage following hemipelvectomy have been described mainly when the conventional flap is unavailable owing to tumor involvement. We report a case of hip disarticulation for a decubitus ulcer with underlying osteomyelitis of the proximal femur; coverage was obtained using an anterior myocutaneous flap. In this case, two previous unsuccessful attempts at wound coverage prior to the hip disarticulation using a lateral and a posterior flap made the anterior flap the best available option for closure. Complete healing was achieved within two months.- - - - - - - - - - ranking = 0.14285714285714keywords = ulcer (Clic here for more details about this article) |
8/156. Maggot therapy for the treatment of intractable wounds.BACKGROUND: Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in israel. methods: Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted. RESULTS: Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy. CONCLUSIONS: Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.- - - - - - - - - - ranking = 0.28580066162163keywords = ulcer, foot (Clic here for more details about this article) |
9/156. The lumbar artery perforator based island flap: anatomical study and case reports.A lumbar artery island flap can be elevated based on a single lumbar artery. We studied the vascular anatomy using 21 specimens of lumbar arteries in 11 cadavers, and investigated the skin territory of the artery using fluorescein injection. We observed lumbar perforators emerging through the lumbar fascia at the lateral border of the erector spinae muscle, situated 5-9 cm from the midline. The diameter of the vascular bundle at the site of perforation ranged from 1 to 5 mm. Perforators of the second and fourth lumbar arteries were much more developed than others. The cutaneous territory supplied by the second lumbar artery extended from the posterior midline to the lateral border of the rectus sheath, and at least 10 cm above the anterosuperior iliac spine. We transferred four clinical flaps for coverage of ulcers on the lower back. All flaps survived and their donor site defects were closed primarily. The cadaver dissection, the injection study and our clinical success have confirmed the feasibility of lumbar artery island flaps.- - - - - - - - - - ranking = 0.14285714285714keywords = ulcer (Clic here for more details about this article) |
10/156. The reversal sural artery neurocutaneous island flap in composite lower extremity wound reconstruction.Reconstruction of the lower third of the leg and the forefoot remains a challenge due to a lack of regional muscle units and minimal subcutaneous tissues. Reverse island flaps have been applied to similar reconstructive problems in the upper extremity. Recently, the reverse sural artery neurocutaneous island flap has been utilized to reconstruct complex wounds of the lower extremity and forefoot in young and middle-aged individuals. We present our use of the flap in a patient cohort 65 years of age or older. Unique among this group was the high prevalence of diabetes and peripheral vascular disease. Nonetheless, the reverse sural artery neurocutaneous island flap proved a safe and reliable means of achieving wound closure.- - - - - - - - - - ranking = 0.00017275181468949keywords = foot (Clic here for more details about this article) |
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