​Surgery - Pressure Sores

​Surgery - Pressure Sores 
Introduction 
an area usually over bony prominences where pressure, shear, and/or friction have damaged the skin and underlying tissue.

Etiology 
Tissue perfusion is hampered when external pressure rises over the capillary filling pressure (32 mmHg), which leads to ischaemia, acidosis, and waste product buildup. Early tissue damage symptoms include non-blanching erythema in the dermis, which is a sign of perivascular hemorrhage from capillaries. Cell death and tissue necrosis occur in the dermis, subcutaneous tissue, and finally the epidermis over time.

RIsk Factors 
extrinsic: moisture, friction, shear, and pressure.
 Intrinsic factors include age, incapacity, sensory impairment, incontinence, protein-calorie deficiency (a threefold increase in risk is associated with every 10 g/L drop in albumin), comorbidity, and prior pressure injury.

Epidemiology 
Typically, 3–10% of hospitalized patients and residents of nursing homes are over 70 years old, and the UK's annual costs—which primarily consist of nursing time—are expected to be over £2.1 billion.


History 
Caretaker may observe an area of erythema or ulcer; less often, patient complaints of pain in the affected area occur. contributing elements. The majority of injuries develop within the first two weeks of hospitalization, and the causing injury may have happened early in the stay, such as while the patient was on the operating table.

Examination 
The sacrum, coccyx, ischial tuberosities, greater trochanter, malleoli, heels, occiput, and scapulae are among the vulnerable regions.
Stage I: Irritable skin that does not blanch and has unbroken skin. 
Stage II: Dermal ulcer involving the shallow layer (may form a blister).
Stage III: The entire dermis thickness, spreading into the subcutaneous layer.
Stage IV: Invading a tendon, bone, muscle, or joint in addition to deep fascia.
As an example, Stage IV ulcers do not always begin and proceed through Stages I, II, and III. Therefore, this system cannot be used to monitor progression or healing.
It is normal and inevitable for bacteria to colonize wounds; nevertheless, an infection should only be recognized in the event that purulent exudates, erythema, an odor, or systemic symptoms (such as fever) are present.

Investigations 
blood cultures and wound swabs in case of suspected infection.
If underlying osteomyelitis is suspected, standard radiographs, MRIs, bone or 67Gallium scans, or needle bone biopsies may be used.


Management 

The secret is to prevent: Risk evaluation (e.g., Waterlow scores), nutritional status evaluation, and avoiding prolonged bed rest.
Reducing pressure by rotating the patient every two hours. By distributing the pressure between the patient and the bed, pressure-reducing devices—static or dynamic—such as foam or air mattresses, can help prevent pressure on sensitive areas, such as the sacrum, trochanters, and heels.
Management of wounds: decrease in pressure. evaluating the wound's severity, removing necrotic tissue, and adjusting the surrounding conditions to encourage granulation and reepithelialization.
Use of suitable dressings (e.g., hydrocolloid, hydrogel, or alginates) that offer moisture balance, bacterial balance, and debridement. Infection prevention and treatment, nutritional considerations (supplementing zinc and vitamin C deficient individuals).
Surgery: Only available for Stage III or IV ulcers. Debridement of necrotic material and myocutaneous flap rebuilding of the damaged area are crucial because they have a high complication rate and require careful pre- and post-operative management.

Complications 
infection (such as osteomyelitis or cellulitis), persistent sores, and recurrent tendencies.

Prognosis 
Since just one-third of Stage IV pressure ulcers have healed after six months and Stage III may require several weeks of care, prevention is essential.