Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem.
A C3 quadriplegic was admitted to our unit, and the whole team went into action to set up a full program of rehabilitation. But the patient decided that he preferred to die. This case raised important ethical questions about patient autonomy and the right to refuse treatment versus medical paternalism, by which the healthcare provider makes decisions on the patient's behalf. This article discusses the ethical principles involved and draws comparisons with other cases cited in the literature. "Tom" is a pseudonym, used to protect the patient's identity. Two Ethical Perspectives follow the article.
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