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Pressure Ulcers of the Lower Limb

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Ulcers of the Lower Extremity

Abstract

Pressure ulcers are a type of injury that breaks down the skin and underlying tissue when an area of skin is placed under constant pressure for certain period of time causing tissue ischemia, cessation of nutrition and oxygen supply to the tissues, and eventually tissue necrosis. Constant pressure resulting in “distortion or deformation damage” is probably the most accurate description of a pressure ulcer [1]. Pressure ulcers can range in severity from patches of discolored skin to open wounds that expose the underlying muscles, bones, and joints.

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References

  1. Krzysztof S. Gebhardt. Part 1. Causes of pressure ulcers. Nurs Times. 2002;98(11):4.

    Google Scholar 

  2. Gefen A. Reswick and Rogers pressure–time curve for pressure ulcer risk, Part-1. Nurs Stand. 2009;23(45):64, 66, 68 passim.

    Google Scholar 

  3. Gefen A. Reswick and Rogers Pressure–time curve for Pressure ulcer risk, Part-2. Nurs Stand. 2009;23(46):40–4.

    Article  CAS  PubMed  Google Scholar 

  4. Callam MJ, Ruckley CV, Dale JJ, et al. Chronic ulceration of the leg: extent of the problem and provision of care. Br Med J. 1985;290:1855–6.

    Article  CAS  Google Scholar 

  5. Leblebici B, Turhan N, Adam M, Akman MN. Clinical and epidemiologic evaluation of pressure ulcers in patients at a university hospital in Turkey. J Wound Ostomy Continence Nurs. 2007;34(4):407–11.

    Article  PubMed  Google Scholar 

  6. Revis DR. Decubitus ulcers. In: Jacocks A, et al., editors. eMedicine. Medscape. 10 Sept 2004.

    Google Scholar 

  7. Cannon BC, Cannon JP. Management of pressure ulcers. Am J Health Syst Pharm. 2004;61:1895–905; quiz 1906–7.

    PubMed  Google Scholar 

  8. Dodd KT, Gross DR. Three-dimensional tissue deformation in subcutaneous tissues overlying bony prominences may help to explain external load transfer to the interstitium. J Biomech. 1991;24(1):11–9.

    Article  CAS  PubMed  Google Scholar 

  9. Jay R. Pressure and shear: their effects on support surface choice. Ostomy Wound Manage. 1995;41:36–8, 40–2, 44–5.

    Google Scholar 

  10. Kuffler DP. Techniques for wound healing with a focus on pressure ulcers elimination. Open Circ Vasc J. 2010;3:72–84.

    Article  Google Scholar 

  11. Goossens RH, Snijders CJ, Holscher TG, Heerens WC, Holman AE. Shear stress measured on beds and wheelchairs. Scand J Rehabil Med. 1997;29(3):131–6.

    CAS  PubMed  Google Scholar 

  12. Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med. 1997;13(3):421–36. Review.

    CAS  PubMed  Google Scholar 

  13. Bliss MR. Hyperaemia. J Tissue Viability. 1998;8(4):4–13. Review.

    Article  CAS  PubMed  Google Scholar 

  14. Langemo D, Anderson J, Hanson D, Hunter S, Thompson P, Posthauer ME. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19:297–8, 300, 303.

    Google Scholar 

  15. Scivoletto G, Fuoco U, Morganti B, Cosentino E, Molinari M. Pressure sores and blood and serum dysmetabolism in spinal cord injury patients. Spinal Cord. 2004;42:473–6.

    Article  CAS  PubMed  Google Scholar 

  16. Keast DH, Fraser C. Treatment of chronic skin ulcers in individuals with anemia of chronic disease using recombinant human erythropoietin (EPO): a review of four cases. Ostomy Wound Manage. 2004;50:64–70.

    PubMed  Google Scholar 

  17. Narsete TA, Orgel MG, Smith D. Pressure sores. Am Fam Physician. 1983;28:135–9.

    CAS  PubMed  Google Scholar 

  18. Ferrell BA, Josephson K, Norvid P, Alcorn H. Pressure ulcers among patients admitted to home care. J Am Geriatr Soc. 2000;48:1042–7.

    Article  CAS  PubMed  Google Scholar 

  19. Berlowitz DR, Brandeis GH, Anderson J, Brand HK. Predictors of pressure ulcer healing among long-term care residents. J Am Geriatr Soc. 1997;45:30–4.

    Article  CAS  PubMed  Google Scholar 

  20. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM. Preventive foot care in people with diabetes. Diabetes Care. 1998;21:2161–77.

    Article  CAS  PubMed  Google Scholar 

  21. Malgrange D, Richard JL, Leymarie F. Screening diabetic patients at risk for foot ulceration. A multi-centre hospital-based study in France. Diabetes Metab. 2003;13(3):261–8. doi:10.1016/S1262-3636(07)70035-6.

    Article  Google Scholar 

  22. Aliasgharpour M, Nayeri ND. The care process of diabetic foot ulcer patients: a qualitative study in Iran. J Diabetes Metab Disord. 2012;11(1):27.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg. 1969;56(9):676–9.

    Article  CAS  PubMed  Google Scholar 

  24. Grayson ML, Gibbons GW, Balogh K, et al. Probing to bone in infected pedal ulcers. JAMA. 1995;27:721–3.

    Article  Google Scholar 

  25. Lowthian P. The classification and grading of pressure ulcers. 1987. J Tissue Viability. 2005;15:15–8.

    Article  PubMed  Google Scholar 

  26. Nixon J, Cranny G, Bond S. Pathology, diagnosis, and classification of pressure ulcers: comparing clinical and imaging techniques. Wound Repair Regen. 2005;13:365–72.

    Article  PubMed  Google Scholar 

  27. Bethell E. Controversies in classifying and assessing grade 1 pressure ulcers. Nurs Times. 2003;99:73–5.

    PubMed  Google Scholar 

  28. Mumcuoglu KY, Lipo M, Ioffe-Uspensky I, Miller J, Galun R. Maggot therapy for gangrene and osteomyelitis. Harefuah. 1997;132:323–5, 382.

    CAS  PubMed  Google Scholar 

  29. Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen. 2002;10:208–14.

    Article  PubMed  Google Scholar 

  30. Moore ZE, Cowman S. Wound cleansing for pressure ulcers. Cochrane Database Sys Rev. 2005;3:CD004983.

    Google Scholar 

  31. Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds. 2006;5:40–54.

    Article  CAS  PubMed  Google Scholar 

  32. Loree S, Dompmartin A, Penven K, Harel D, Leroy D. Is Vacuum Assisted Closure a valid technique for debriding chronic leg ulcers? J Wound Care. 2004;13:249–52.

    Article  CAS  PubMed  Google Scholar 

  33. Payne WG, Ochs DE, Meltzer DD, Hill DP, Mannari RJ, Robson LE, Robson MC. Long-term outcome study of growth factor-treated pressure ulcers. Am J Surg. 2001;181:81–6.

    Article  CAS  PubMed  Google Scholar 

  34. Marston WA. Dermagraft, a bioengineered human dermal equivalent for the treatment of chronic nonhealing diabetic foot ulcer. Expert Rev Med Devices. 2004;1:21–31.

    Article  CAS  PubMed  Google Scholar 

  35. Sarasúa JG, López SP, MÁ V, Basterrechea MP, Rodríguez AF, Gutiérrez AF, Gala JG, Menéndez YM, Augusto DE, Arias AP, Hernández JO. Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury. J Spinal Cord Med. 2011;34(3):301–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kamata Y, Takahashi Y, Iwamoto M, Matsui K, Murakami Y, Muroi K, et al. Local implantation of autologous mononuclear cells from bone marrow and peripheral blood for treatment of ischaemic digits in patients with connective tissue diseases. Rheumatology (Oxford). 2007;46(5):882–4. [PubMed].

    Article  CAS  Google Scholar 

  37. Robson MC, Hill DP, Smith PD, Wang X, Meyer-Siegler K, Ko F, VandeBerg JS, Payne WG, Ochs D, Robson LE. Sequential cytokine therapy for pressure ulcers: clinical and mechanistic response. Ann Surg. 2000;231(4):600–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Fischer BH. Topical hyperbaric oxygen treatment for pressure sores and skin ulcers. Lancet. 1969;294(7617):405–9.

    Article  Google Scholar 

  39. Chen L, Tredget EE, Wu PY, Wu Y. Paracrine factors of mesenchymal stem cells recruit macrophages and endothelial lineage cells and enhance wound healing. PLoS One. 2008;3(4), e1886.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Schönfeld M, Moll I, Maier K, Jung EG. Keratinocytes from cell culture for therapy of skin defects. Review and personal results. Hautarzt. 1993;44(5):281–9.

    PubMed  Google Scholar 

  41. Kuroyanagi Y, Yamada N, Yamashita R, Uchinuma E. Tissue-engineered product: allogeneic cultured dermal substitute composed of spongy collagen with fibroblasts. Artif Organs. 2001;25(3):180–6.

    Article  CAS  PubMed  Google Scholar 

  42. Ichioka S, Ohura N, Sekiya N, Shibata M, Nakatsuka T. Regenerative surgery for sacral pressure ulcers using collagen matrix substitute dermis (artificial dermis). Ann Plast Surg. 2003;51(4):383–9.

    Article  PubMed  Google Scholar 

  43. Mizuno H, Miyamoto M, Shimamoto M, Koike S, Hyakusoku H, Kuroyanagi Y. Therapeutic angiogenesis by autologous bone marrow cell implantation together with allogeneic cultured dermal substitute for intractable ulcers in critical limb ischaemia. J Plast Reconstr Aesthet Surg. 2010;63(11):1875–82.

    Article  PubMed  Google Scholar 

  44. Tang YL, Zhao Q, Zhang YC, Cheng L, Liu M, Shi J, et al. Autologous mesenchymal stem cell transplantation induce VEGF and neovascularization in ischemic myocardium. Regul Pept. 2004;117(1):3–10.

    Article  CAS  PubMed  Google Scholar 

  45. Ono I, Yamashita T, Hida T, Jin HY, Ito Y, Hamada H, et al. Local administration of hepatocyte growth factor gene enhances the regeneration of dermis in acute incisional wounds. J Surg Res. 2004;120(1):47–55.

    Article  CAS  PubMed  Google Scholar 

  46. Caplan AI, Dennis JE. Mesenchymal stem cells as trophic mediators. J Cell Biochem. 2006;98(5):1076–84.

    Article  CAS  PubMed  Google Scholar 

  47. Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13:4279–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Strioga M, Viswanathan S, Darinskas A, Slaby O, Michalek J. Same or not the same? Comparison of adipose tissue-derived versus bone marrow derived mesenchymal stem and stromal cells. Stem Cells Dev. 2012;21:2724–52.

    Article  CAS  PubMed  Google Scholar 

  49. Jiang L, Dai Y, Cui F, Pan Y, Zhang H, Xiao J, Xiaobing FU. Expression of cytokines, growth factors and apoptosis-related signal molecules in chronic pressure ulcer wounds healing. Spinal Cord. 2014;52(2):145–51.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to S. Bhattacharya .

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Mishra, R.K., Bhattacharya, S. (2016). Pressure Ulcers of the Lower Limb. In: Khanna, A., Tiwary, S. (eds) Ulcers of the Lower Extremity. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2635-2_20

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  • DOI: https://doi.org/10.1007/978-81-322-2635-2_20

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