Pressure Sores in the Elderly
Capillary perfusion pressure is the source of life for all the cells in our body, and yet, it averages a modest 22 mmHg throughout most systems in the body. Venous capillary closing pressure is about 12 mmHg, and arterial capillary pressure about 32 mmHg . This delicate homeostasis can be upset by something as simple as excessive external pressure on tissue. This situation requires two unyielding surfaces: one an underlying bony prominence and the other an external plane such as a bed, chair, or even a transport gurney. The most common bony surfaces involved, in order of occurrence, are the sacrum, calcaneus, ischium, and greater trochanter . In fact, these areas are subject to pressure exceeding 30 mmHg when lying supine, sitting, or lying on the side, respectively . This situation is usually benign as our autonomic nervous system prompts us to shift our weight frequently to avoid chronic pressure.
KeywordsPressure Ulcer Pressure Sore Advancement Flap Gluteus Maximus Fasciocutaneous Flap
The authors wish to thank David S. Chang, MD, for contributing clinical case photographs for the posterior thigh flap.
- 1.Landis E (1930) Micro-injection studies of capillary blood pressure in human skin. Heart 15:209–228Google Scholar
- 19.Pressure Ulcer Stages Revised by NPUAP. http://www.npuap.org/pr2.htm. Accessed 18 January 2009
- 22.McInnes E, Bell-Syer SE, Dumville JC, Legood R, Cullum NA (2008) Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev (4):CD001735Google Scholar
- 24.Bergstrom N, Bennett MA, Carlson CE, et al (1994) Treatment of pressure ulcers. Clinical practice guideline, no. 15. U.S. Department of Health and Human Services. Public Health Service AHCPR, ed, Rockville, MDGoogle Scholar
- 33.Mathes SJ, Nahai F (1997) Tensor Fascia Lata (TFL) flap. Reconstr Surg 1271–1292Google Scholar
- 35.Constantian M (1980) Pressure ulcers: principles and techniques of management. Little, Brown, Boston, MAGoogle Scholar