Cases reported "Pressure Ulcer"

Filter by keywords:



Filtering documents. Please wait...

1/27. 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 = 1
keywords = operative
(Clic here for more details about this article)

2/27. Free flaps for reconstruction of the lower back and sacral area.

    Free flap reconstruction of the lower back and sacrum is complicated by a paucity of recipient vessels and difficulties in postoperative care. From 1983 to 1997, six patients with intractable wounds of the lower back and sacral area were treated with free flaps. The flaps used were latissimus dorsi (three), combined latissimus dorsi and serratus anterior (one), and filleted leg tissue (two). The recipient vessels were the deep femoral vessels, the perforator vessels of the deep femoral system, the inferior epigastric vessels, and the superior gluteal and inferior gluteal vessels. The patients were observed in the intensive care unit for 1 week and kept in prone position for 4 weeks. All flaps survived and wounds healed primarily. For large or multiple defects of the lower back and sacrum, free tissue transfer is effective in achieving primary healing, particularly when local flaps are inadequate or have failed.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

3/27. Effects of warming therapy on pressure ulcers--a randomized trial.

    Postoperative pressure ulcers are a common and expensive problem. Intraoperative hypothermia also is a common problem and may have a connection with impaired tissue viability. Researchers in this study hypothesized that intraoperative control of hypothermia may reduce the incidence of postoperative pressure ulcers. A randomized clinical trial (n = 338) was used to test the effects of using forced air warming therapy versus standard care. Results indicated an absolute risk reduction in pressure ulcers of 4.8% (i.e., 10.4% to 5.6%) with a relative risk reduction of 46% in patients who received warming therapy. Although not reaching statistical significance, the clinical significance of almost halving the pressure ulcer rate is important. A correlation between body temperature and postoperative pressure ulcers was established.
- - - - - - - - - -
ranking = 5
keywords = operative
(Clic here for more details about this article)

4/27. The role of plasma transglutaminase (F XIII) in wound healing of complicated pressure sores after spinal cord injury.

    STUDY DESIGN: A case report. OBJECTIVES: To demonstrate stimulating action of F XIII in wound healing of complicated pressure sores. SETTING: A spinal cord Injury Center in germany. methods: Clinical exam, clinical and photographic wound control, biochemical serum monitoring. RESULTS: Recurrent pressure sores in plegic patients are common complications requiring long-standing conservative or operative therapy. Additional risk factors such as diabetes increase the complication rate for surgery. Surgery itself may be difficult in recurrent pressure sores due to limited remaining soft tissues. We report the case and treatment of a 47-year-old patient with long-standing and recurrent ulcers and complications after flap surgery. As a final option we added plasma transglutaminase (factor xiii) to our treatment scheme which changed the course of the disease dramatically and we achieved complete and rapid healing. CONCLUSION: Our experience suggests that F XIII has a positive role in treating pressure sores as shown already in several other surgical fields. Its use is giving the surgeon an additional tool in complicated cases.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

5/27. spinal cord injury in children.

    The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

6/27. Oh my, the pressure!

    The intraoperative phase of a surgical patient's hospital stay has been overlooked as a major contributor of pressure ulcers that may arise postoperatively. Pressure ulcers are defined and then the hazards, underlying knowledge, and prevention tactics are reviewed. Bed sore, decubitous ulcer, pressure sore, and pressure ulcer are different terms describing the same problem encountered by medical and surgical patients. The common denominator is pressure--sustained pressure.
- - - - - - - - - -
ranking = 2
keywords = operative
(Clic here for more details about this article)

7/27. rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese.

    BACKGROUND: rhabdomyolysis is a well-known cause of renal failure and is most commonly caused by ischemia/reperfusion or crush injury. We describe a new cause of this syndrome in a series of 6 patients who underwent necrosis of the gluteal muscles after bariatric surgery, 3 of whom eventually died of renal failure. methods: Potential etiologic factors were studied by comparing these patients with a consecutive series of 100 patients undergoing primary uncomplicated bariatric surgery during a 1-year period. Demographics, preoperative BMI, co-morbidities, duration of operation, and postoperative creatinine phosphokinase (CPK) levels. RESULTS: All patients presented with an area of buttock skin breakdown initially diagnosed as a simple decubitus ulcer. All had extensive myonecrosis of the medial gluteal muscles requiring extensive debridement. 5 of the 6 patients were male, with median BMI 67 compared with a median BMI 55 in the control group (P=0.0022). The patients were on the operating-room table for a median of 5.7 hours compared with 4.0 in the control group (P=0.01). 3 of the 6 developed renal failure requiring dialysis, which was fatal in all. One other patient developed a transient elevation of BUN and creatinine which did not require dialysis. Since recognition of this pattern, we now routinely perform serial CPK measurements. Median CPK rise in uncomplicated patients was to 1,200 mg/dl (SD 450-9,000), while CPK in affected patients ranged from 26,000 to 29,000 IU/l. We now routinely add additional buttock padding in very obese patients and institute aggressive hydration and mannitol diuresis if CPK rises above 5,000. No cases have occurred in the past 18 months in 220 patients. CONCLUSIONS: This is an important and potentially fatal complication of bariatric surgery. Very obese male patients with prolonged surgery are at risk of gluteal muscle necrosis with consequent renal failure, which we hypothesize is due to pressure by the operating-table leading to rhabdomyolysis and the creation of a compartment syndrome. Prevention may be aided by attention to intraoperative padding and positioning, and by limiting the duration of the operation.
- - - - - - - - - -
ranking = 3
keywords = operative
(Clic here for more details about this article)

8/27. Verrucous carcinoma of the foot from chronic pressure ulcer.

    STUDY DESIGN: This is a case report with literature review. OBJECTIVE: To describe a case of verrucous carcinoma, a rare histopathologic type, complicating a chronic pressure ulcer of duration less than 3 years. SETTING: The department of Physical medicine and rehabilitation, University of north carolina at Chapel Hill, USA. METHOD: A 24-year-old African-American male with long-standing incomplete paraplegia visited the wound clinic due to a pressure ulcer that had lasted for more than 1 year on the medial side of the right foot. Despite conservative management for almost 2 years after the initial visit, the ulcer is suspected to have undergone malignant transformation. Histological study led to the diagnosis of verrucous carcinoma that necessitated transtibial amputation on the right foot. RESULT: The carcinoma developed within 3 years, which was a relatively short time period for a pressure ulcer to have undergone malignant transformation. The diagnosis of verrucous carcinoma has never been reported as carcinoma complicating a pressure ulcer. No evidence of local recurrence or distant metastasis was seen in postoperative 10 months. CONCLUSION: The possibility of malignant transformation should be kept in mind in cases of pressure ulcers that are unresponsive to treatment or that show morphological changes suspected to be cancerous. Furthermore, early detection and intervention increases the probability for successful outcome.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

9/27. The gluteal perforator-based flap in repair of pressure sores.

    The gluteal perforator-based flap is designed according to the localisation of sacral perforator vessels. These vessels penetrate the gluteus maximus muscle and reach the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus. The gluteal perforator-based flaps described in this paper are highly-vascularised, have minimal donor site morbidity, do not require the sacrifice of the gluteus maximus muscle and rarely lead to post-operative complications. We believe these easy-to-perform flaps might be considered as the first choice in the repair of gluteal pressure sores.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

10/27. Extracorporeal expulsion of a vascular endograft used to treat a mycotic aneurysm.

    A 65-year-old woman with a right common iliac artery mycotic aneurysm and an overlying sacral pressure ulcer was treated with placement of a vascular endograft. The mycotic aneurysm was successfully excluded, but 3 months after the procedure, the endograft was expelled through the wound. Fortunately, the patient had minimal clinical sequelae. This case emphasizes the importance of frequent noninvasive imaging of mycotic aneurysms treated with endografts. A rigorous postoperative imaging protocol is proposed based on the current regimen for abdominal aortic aneurysm surveillance after endograft implantation.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Pressure Ulcer'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.