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Operative debridement of pressure ulcers.

Schiffman J, Golinko MS, Yan A, Flattau A, Tomic-Canic M, Brem H - World J Surg (2009)

Bottom Line: Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%).The postoperative hospital stay averaged 4.1 days.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.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.

ABSTRACT

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 cm(2), 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.

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Related in: MedlinePlus

Exploration of the wound for undermining can be performed with a gloved finger or a sterile cotton swab, as depicted here
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Fig1: Exploration of the wound for undermining can be performed with a gloved finger or a sterile cotton swab, as depicted here

Mentions: Prior to operation, the surgeon explored the wound for undermining, using a swab or gloved finger (Fig. 1). Undermining is defined by CMS as the destruction of tissue or ulceration extending under the skin edges such that the pressure ulcer measures larger at its base than at the skin surface [29]. For patients with sacral or ischial pressure ulcers, a rectal exam was performed, and the area overlying the rectum was indicated with a marking pen. During debridement, the perirectal fibrinous tissue may be removed, but deep penetration to the rectal muscle should be avoided.Fig. 1


Operative debridement of pressure ulcers.

Schiffman J, Golinko MS, Yan A, Flattau A, Tomic-Canic M, Brem H - World J Surg (2009)

Exploration of the wound for undermining can be performed with a gloved finger or a sterile cotton swab, as depicted here
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2691928&req=5

Fig1: Exploration of the wound for undermining can be performed with a gloved finger or a sterile cotton swab, as depicted here
Mentions: Prior to operation, the surgeon explored the wound for undermining, using a swab or gloved finger (Fig. 1). Undermining is defined by CMS as the destruction of tissue or ulceration extending under the skin edges such that the pressure ulcer measures larger at its base than at the skin surface [29]. For patients with sacral or ischial pressure ulcers, a rectal exam was performed, and the area overlying the rectum was indicated with a marking pen. During debridement, the perirectal fibrinous tissue may be removed, but deep penetration to the rectal muscle should be avoided.Fig. 1

Bottom Line: Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%).The postoperative hospital stay averaged 4.1 days.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.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.

ABSTRACT

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 cm(2), 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.

Show MeSH
Related in: MedlinePlus