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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

Triangular segment of skin removed and sent to pathology
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Fig4: Triangular segment of skin removed and sent to pathology

Mentions: The wound was widely prepped in order to capture the outermost area of undermining. Segments of the overlying tissue were resected to expose areas of undermining. This tissue usually includes healthy-appearing skin as well as the underlying subcutaneous tissue and fascia, and it is resected in triangular segments, using electrocautery to minimize bleeding. As Figs. 2 and 3 illustrate, the apex of the triangle should extend to the outermost circumference of the area of undermining, and the base of the triangle should be adjacent to the outer edge of the wound. The resected area should be restricted to the minimum amount needed to expose the pockets of undermining and to allow for debridement of underlying necrotic tissue and full exposure of the wound bed. This resection will also allow for deep packing in dressing changes. Although healthy skin is removed, this skin typically heals faster than tissue at the base of the wound (Fig. 4).Fig. 2


Operative debridement of pressure ulcers.

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

Triangular segment of skin removed and sent to pathology
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: Triangular segment of skin removed and sent to pathology
Mentions: The wound was widely prepped in order to capture the outermost area of undermining. Segments of the overlying tissue were resected to expose areas of undermining. This tissue usually includes healthy-appearing skin as well as the underlying subcutaneous tissue and fascia, and it is resected in triangular segments, using electrocautery to minimize bleeding. As Figs. 2 and 3 illustrate, the apex of the triangle should extend to the outermost circumference of the area of undermining, and the base of the triangle should be adjacent to the outer edge of the wound. The resected area should be restricted to the minimum amount needed to expose the pockets of undermining and to allow for debridement of underlying necrotic tissue and full exposure of the wound bed. This resection will also allow for deep packing in dressing changes. Although healthy skin is removed, this skin typically heals faster than tissue at the base of the wound (Fig. 4).Fig. 2

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