Medical device related pressure ulcer of the lip in a patient with COVID-19: Case report and review of the literature

Abstract

Pressure ulcers of the lip constitute a rare entity faced by plastic surgeons and there is a relatively paucity of data regarding optimal management. In this study we present one case of upper lip pressure ulcer related to prone intubation for respiratory distress due to SARS-CoV-2 infection, treated with surgical excision and reconstruction. We also performed a review of the literature to identify other studies on pressure lip ulcers. Six studies were considered relevant. Conservative management constitutes the most common method of treatment; however, little is known about the aesthetic, and functional morbidity related to either surgical or non-surgical treatments.

Oral Complications of ICU Patients with COVID-19: Case-Series and Review of Two Hundred Ten Cases

“…On reviewing the emerging evidence on ICU-related complications in COVID-19 patients, fourteen studies (one cohort study [20], two case-control studies [21,22], one cross-sectional study [23], two case-series [24,25], and eight case-reports [26][27][28][29][30][31][32][33]) with two hundred ten patients met the inclusion criteria. The majority of the cases were from the Americas (USA n = 103, 49.5%; Brazil n = 4, 1.9%), followed by Europe (Spain n = 57, 27.1%; UK n = 16, 7.6%; France n = 2, 1%; and Italy n = 2, 1%), and Middle East (Iran n = 26, 12.4%).…”

“…The perioral (facial) pressure ulcers have been the most prevalent ICU-related oral complication in COVID-19 patients reported by ten studies in one hundred seventy-nine patients; 73.75% of them were males, and the vast majority were of old age [20][21][22][23]25,[29][30][31][32][33]. Prolonged pronation and endotracheal intubation were the most evident risk factors for perioral pressure ulcers.…”

Oral care and photobiomodulation protocol for the prevention of traumatic injuries and lip necrosis in critically ill patients with COVID-19: an observational study

“…Clinical reports have described the presence of lesions in the oral mucosa, especially in patients with severe COVID-19. Their clinical features include different patterns, such as aphthous-like oral ulcers, hemorrhagic ulcerations, oral ulcers with necrotic areas, petechiae, herpetic-like lesions, geographical tongue, vesiculobullous lesions, and mucosal pigmentation [3][4][5][6][7][8][9][10][11]. It is still unclear if these lesions can be directly related to COVID-19.…”

“…Oral traumatic injuries (usually located on the lips region) may develop due to the prolonged time that patients may remain intubated and, sometimes, for being maintained in a prone position. Other oral traumatic injuries may also include traumatic bites [9,[13][14][15][16].…”

“…Medical device-related pressure ulcers (PU) are a major issue among the hospitalized patients, and generally represent 34.5% of all hospital-acquired PU. PU of the mouth and lips are not that commonly reported, accounting for 3.4% [17] of the medical device-associated PU, but very frequently related to endotracheal tubes [9]. This data is even more scarce regarding COVID-19 critically ill patients, which develop several oral complications (including traumatic injuries) with an underreported frequency [9,16].…”