PRESSURE SORE PREVENTION & MANAGEMENT
Prolonged and Excessive Pressure leading to an Ulcer is called as Pressure sore, as they usually develop in bed so also called bed sore.
Pressure of 70 mm of Hg applied for more then 2 hrs causes irreversible tissue damage. Fat and Muscle tolerate pressure less, as Compared to Skin so necrosis on subcutaneous tissue and muscle is more as compare to skin giving ulcer cone shape.
PREVENTION OF PRESSURE SORE
Frequent change of position—HALF HOURLY.
Maintain local hygiene.
Keep skin dry.
No wrinkles of bed sheet.
Water mattress/Air mattress.
Gentle message/ love touch.
Watch for any skin change.
“BED SORE IS NO MORE EARLY SIGN OF DEATH BUT IT IS SIGN OF NEGLIENCE.”
CARE OF PRESSURE SORE
CARE OF PATIENT IN TOTO IS THE CARE OF PRESSURE SORE.
Treatment of Malnutrition, Anemia, infection and if possible underlying disease.
DRESSING OF ULCER
Frequency—when ever dressing is wet
Use very thick cotton pads
Debridment, wound cleaning
SURGICAL MANAGEMENT—Surgery is not the substitute of care, rather a proper care is pre-requisite for reconstructive surgery of pressure sore.
Debridment—Excision of ulcer in Toto i.e. Guttaman’s technique
RECONSTRUCTION OF SORES- use of various flaps. These flaps are faciocutaneous, muscle and myocutaneous flaps.
Large Ulcer over Ischeal tuberocity.Wide excision,Gluteous Maximus Myocutaneous inferiorly based flap done.
CASE---Large sacral pressure sore in a young paraplegic patient. Treated with bilateral Gluteous maximus myocutaneous flap.Ucer healed uneventfully without any donor side defect.