SURGICAL INTERVERNTIONS
IN PRESSURE SORE
MANAGEMENT AT CRP
Presented by : Dr. Shamim Khan
RMO, Medical Care
Services
CRP, ...
PRESSURE SORE
 Pressure sores are localized areas of
tissue breakdown in skin and/or underlying
tissues that develop when...
Patient Populations at High Risk
 Paraplegic or tetraplegic patients
 Patients with decreased sensation due to neurologi...
Areas Prone to the Development of
Pressure Sores
 More common
• Scrum
• Trochanter
• Ischial tuberosity
 Less common
• C...
Patients Admitted with Pressure
Sore at CRP on 2007
 Total patients : 415
 Total patients with pressure sore : 173 (30% ...
Pressure Sore Staging System
 Stage I : Redness of intact skin that does not
blanch.
 Stage II : Partial-thickness skin ...
Treatment of STAGE I and II
Pressure Sore
 Keep the affected tissue clean and the
surrounding area dry by regular daily
d...
Treatment of STAGE III and IV
Pressure Sore
 If the wound has a red, granulating base :
Apply saline dressing daily.
 If...
Dressing Materials
 Normal Saline
 Betadine solution
 EUSOL solution
 Spirit
 Betadine ointment
Out come of Regular
Wound Dressing
On Admission Two months later
Surgical Intervention
 Wound Debridement
 Skin Grafting
 Plastic surgery
Wound Debridement
 When a wound is covered with black, dead
tissue or thick gray/green exudates, surgical
removal of necr...
Out Come of Debridement and Dressing
Before After
Skin Grafting
 Cross-section of human skin showing the
epidermis, dermis and subcutaneous tissue.
 The relative thicknes...
Split-thickness Skin Graft
 Indications :
• Large wound (> 5–6 cm in diameter) that
would take many weeks to heal seconda...
Skin-graft (Humby) knife
Harvesting a split-thickness
graft with the Humby knife.
Wound covered with a split-thickness ski...
Skin Grafting at Sacral Pressure
Sore
Preoperative Postoperative
Two months
before surgery
Plastic Surgery
 End to end closure
 Flaps
Pre requisites of plastic surgery :
 Excellent nutritional status.
 Albumin...
End to End Closure
Preoperative Postoperative
End to End Closure
Preoperative
Postoperative
FLAP
 A flap is a piece of tissue with a blood supply
that can be used to cover an open wound.
 A flap can be created fr...
Random Flaps
 Circulation to a
random flap is
provided in a diffuse
fashion through tiny
vascular connections
from the pe...
Different Types of Random
Flaps
 Rhomboid flap
 Rotation flap
 Tensor fascia lata (TFL) flap
 V-Y advancement flap.
 ...
Rhomboid Flaps
 Rhomboid flaps
are useful for
wounds up to 6
to 8cm in
diameter on the
trunk or
extremity.
 Useful in
pr...
Rhomboid Flaps
Preoperative
5th Postoperative day 15th Postoperative day
Rhomboid Flaps
Pre-operative Pre-operative
10th Post-operative day15th Post-operative day
Rhomboid Flaps
Pre-operative
7th Post-operative day One month later
Rhomboid Flaps
Per-operative pictures
Buttocks Rotation Flap
 Most
commonly
used for sacral
pressure
sore.
 Useful for
sacral wounds
about 10 to
12cm in
diame...
Bilateral Rotation Flap
Pre-operative
Per-operative
Bilateral Rotation Flap
Per-operative pictures
Tensor Fascia Lata (TFL) Flap
 TFL flap is the
most commonly
used for closure
of trochanteric
pressure sore.
 The flap i...
Tensor Fascia Lata (TFL) Flap
Pre-operative
Post-operative
Tensor Fascia Lata (TFL) Flap
Pre-operative
Per-operative
Tensor Fascia Lata (TFL) Flap
Per-operative pictures
General Post Operative Care
 Cleanse and apply antibiotic ointment to the
suture lines daily.
 If a suction drain was us...
Failure of Flap surgery
 Ischemic flap necrosis.
 Infection.
 Haematoma.
 Recurrence of pressure sore at
surgical site.
Graphical Presentation of
Pressure Sore surgeries from
Jan’07 to Apr’08
 Skin Grafting
 Plastic Surger
1
9
5
13
5 5
8
20...
of 38

Pressure sore management

Pressure sores are localized areas of tissue breakdown in skin and/or underlying tissues that develop when persistent pressure between a bony site and underlying surface obstructs healthy capillary flow. Constant external pressure over 70 mm Hg for 2 hours produces irreversible ischemic changes. Synonyms : Pressure ulcer, Decubitus ulcer, Bed sore.
Published on: Mar 4, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Pressure sore management

  • 1. SURGICAL INTERVERNTIONS IN PRESSURE SORE MANAGEMENT AT CRP Presented by : Dr. Shamim Khan RMO, Medical Care Services CRP, SAVAR
  • 2. PRESSURE SORE  Pressure sores are localized areas of tissue breakdown in skin and/or underlying tissues that develop when persistent pressure between a bony site and underlying surface obstructs healthy capillary flow.  Constant external pressure over 70 mm Hg for 2 hours produces irreversible ischemic changes.  Synonyms : Pressure ulcer, Decubitus ulcer,
  • 3. Patient Populations at High Risk  Paraplegic or tetraplegic patients  Patients with decreased sensation due to neurologic disorders, e.g. stroke.  Patients with impaired mental capacity.  Seriously ill patients in an intensive care unit. Additional Risk Factors  Malnutrition  Incontinence  Tobacco use.
  • 4. Areas Prone to the Development of Pressure Sores  More common • Scrum • Trochanter • Ischial tuberosity  Less common • Calcaneum • Malleolus • Scapula • Elbow • Knee
  • 5. Patients Admitted with Pressure Sore at CRP on 2007  Total patients : 415  Total patients with pressure sore : 173 (30% of total)  Male patients with pressure sore : 157 (27%)  Female patients with pressure sore : 16 (3%) Sex distribution among pressure sore patients on 2007 Female 3% Male 27% Total 70%
  • 6. Pressure Sore Staging System  Stage I : Redness of intact skin that does not blanch.  Stage II : Partial-thickness skin loss involving the epidermis and dermis.  Stage III : Full-thickness skin loss involving the underlying subcutaneous fat but not the muscle.  Stage IV : Full-thickness skin loss with extensive destruction, tissue necrosis, or damage in muscle, bone, or supporting structures.
  • 7. Treatment of STAGE I and II Pressure Sore  Keep the affected tissue clean and the surrounding area dry by regular daily dressing.  Apply antibiotic ointment (e.g., Bacitracin, silver sulfadiazine) daily to areas that have blistered.
  • 8. Treatment of STAGE III and IV Pressure Sore  If the wound has a red, granulating base : Apply saline dressing daily.  If the wound contains necrotic tissue : - Surgical debridement is necessary. - Follow with daily dressings, using saline or EUSOL solution.  If the wound is infected : - Treat the patient with a course of antibiotics. - Twice daily dressing with Betadine solution.
  • 9. Dressing Materials  Normal Saline  Betadine solution  EUSOL solution  Spirit  Betadine ointment
  • 10. Out come of Regular Wound Dressing On Admission Two months later
  • 11. Surgical Intervention  Wound Debridement  Skin Grafting  Plastic surgery
  • 12. Wound Debridement  When a wound is covered with black, dead tissue or thick gray/green exudates, surgical removal of necrotic tissue is needed.  Dead bone or tendon in the wound must be removed.  Bleeding tissue is a good sign healthy tissue. Dead tissue does not bleed.  Once the necrotic tissue has been removed, regular Wet-to-dry dressing should be started.
  • 13. Out Come of Debridement and Dressing Before After
  • 14. Skin Grafting  Cross-section of human skin showing the epidermis, dermis and subcutaneous tissue.  The relative thickness of skin grafts is shown.
  • 15. Split-thickness Skin Graft  Indications : • Large wound (> 5–6 cm in diameter) that would take many weeks to heal secondarily. • Wounds that cannot be closed primarily. • Wounds that require more stable coverage than scar.  Contraindications : • Malnourished patient. • Necrotic tissue or signs of infection at the wound • A wound that has exposed tendon or bone.
  • 16. Skin-graft (Humby) knife Harvesting a split-thickness graft with the Humby knife. Wound covered with a split-thickness skin graft.
  • 17. Skin Grafting at Sacral Pressure Sore Preoperative Postoperative Two months before surgery
  • 18. Plastic Surgery  End to end closure  Flaps Pre requisites of plastic surgery :  Excellent nutritional status.  Albumin > 3.5 gm/dl,  Prealbumin > 20mg/dl,  Transferrin > 250 mg/dl (2.5 gm/L).  The patient must not smoke.  Patients should be motivated enough to change positions regularly.
  • 19. End to End Closure Preoperative Postoperative
  • 20. End to End Closure Preoperative Postoperative
  • 21. FLAP  A flap is a piece of tissue with a blood supply that can be used to cover an open wound.  A flap can be created from skin with its underlying subcutaneous tissue, fascia, or muscle. Flap Local Flap Distant Flap Skin Flap Muscle Flap Axial Flap Random Flap
  • 22. Random Flaps  Circulation to a random flap is provided in a diffuse fashion through tiny vascular connections from the pedicle into the flap.  The pedicle must be bulky to increase the number of vascular connections.  The flap should not be longer than 3 times its width. Random skin flap. The blood supply comes diffusely from the remaining skin attachment, which serves as the pedicle.
  • 23. Different Types of Random Flaps  Rhomboid flap  Rotation flap  Tensor fascia lata (TFL) flap  V-Y advancement flap.  Rectangular advancement flap.
  • 24. Rhomboid Flaps  Rhomboid flaps are useful for wounds up to 6 to 8cm in diameter on the trunk or extremity.  Useful in pressure sores with less surrounding tissue laxity.
  • 25. Rhomboid Flaps Preoperative 5th Postoperative day 15th Postoperative day
  • 26. Rhomboid Flaps Pre-operative Pre-operative 10th Post-operative day15th Post-operative day
  • 27. Rhomboid Flaps Pre-operative 7th Post-operative day One month later
  • 28. Rhomboid Flaps Per-operative pictures
  • 29. Buttocks Rotation Flap  Most commonly used for sacral pressure sore.  Useful for sacral wounds about 10 to 12cm in diameter.
  • 30. Bilateral Rotation Flap Pre-operative Per-operative
  • 31. Bilateral Rotation Flap Per-operative pictures
  • 32. Tensor Fascia Lata (TFL) Flap  TFL flap is the most commonly used for closure of trochanteric pressure sore.  The flap is composed of the skin and fascial extension from the TFL muscle.
  • 33. Tensor Fascia Lata (TFL) Flap Pre-operative Post-operative
  • 34. Tensor Fascia Lata (TFL) Flap Pre-operative Per-operative
  • 35. Tensor Fascia Lata (TFL) Flap Per-operative pictures
  • 36. General Post Operative Care  Cleanse and apply antibiotic ointment to the suture lines daily.  If a suction drain was used, it should stay in place at least 1 week.  The patient should apply no pressure to the surgical site until the suture line has healed (usually 2–3 weeks).  Leave the skin sutures in place for at least 14 days unless there are signs of irritation from the sutures.
  • 37. Failure of Flap surgery  Ischemic flap necrosis.  Infection.  Haematoma.  Recurrence of pressure sore at surgical site.
  • 38. Graphical Presentation of Pressure Sore surgeries from Jan’07 to Apr’08  Skin Grafting  Plastic Surger 1 9 5 13 5 5 8 20 0 2 4 6 8 10 12 14 16 18 20 Jan'07 - Apr'07 May'07 - Aug'07 Sep'07- Dec'07 Jan'08- Apr'08

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