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Operative Management of Pressure Injuries

  • Dennis P. OrgillEmail author
Chapter

Abstract

The number of patients with pressure injuries continues to grow due to higher rates of obesity and diabetes as well as an aging population. In addition, there are high rates of pressure injuries in patients with neurological impairment such as spinal cord injuries. Pressure injuries occur in tissues anatomically located between a surface and a bony prominence because of a lack of blood flow. Superficial pressure injuries can be treated conservatively with dressing changes and local skin care. Deeper pressure injuries that go into muscle (Stage 3) or bone (Stage 4) often require surgical repair. Prior to surgery, patients need to be optimized in terms of their medical conditions, nutrition, and support surfaces. Surgery consists of excision of the wound with trimming back of the bony prominence and often using a soft tissue flap for closure. Recurrence rates after surgery are high, particularly if the underlying reasons for developing the pressure injury are not corrected. Doing a well-designed operation in a proper patient can allow them to return to many normal activities, and with proper monitoring, they can be free of ulcerations.

Keywords

Pressure injury Decubitus ulcer Pressure sore surgery Negative-pressure wound therapy Flap closure Osteomyelitis 

Supplementary material

Video 5.1

Treatment of left ischial pressure ulcer debridement with flap closure (AVI 1149437 kb)

References

  1. 1.
    National Pressure Ulcer Advisory Panel. Available at http://www.npuap.org
  2. 2.
    Public Policy Committee and the Wound Subcommittee. Avoidable versus unavoidable pressure ulcers. Wound ostomy and continence nurses society. 2009. Available via http://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/Publications/PS_Avoidable_vs_Unavoidable_.pdf. Accessed 1/7/2017.
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    Ricci JA, Bayer LR, Orgill DP. Evidence-based medicine: the evaluation and treatment of pressure injuries. Plast Reconstr Surg. 2017;139(1):275e–86e.CrossRefPubMedGoogle Scholar
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    Hartzell TL, Orgill BD, Chan R, Mathy JA, Orgill DP. VY modification of a bipedicle perforator flap. Plast Reconstr Surg. 2009;124(1):167–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Plastic SurgeryBrigham and Women’s Hospital Harvard Medical SchoolBostonUSA

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