Outcome analyses of a multimodal treatment approach for deep pressure ulcers in spinal cord injuries: a retrospective cohort study

Abstract

Our multimodal treatment concept was found to have complication rates comparable to those in the literature; additionally, this approach might be associated with lower recurrence rates with respect to the literature. To reduce high rates of pneumonia occurrence among patients with tetraplegia, preventive measures need to be established. Further evidence of the efficiency of this complex treatment approach for PU in individuals with SCI is needed.

Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept

“…Surgical debridement to accelerate the cleaning phase. Wet dressings three times per day or negative pressure wound therapy [36, 38]. Treatment of risk factors and nutritional optimisation Risk screening during this cleaning phase: general internal medical aspects as well as specific SCI risk factors.…”

“…Treatment of risk factors and nutritional optimisation Risk screening during this cleaning phase: general internal medical aspects as well as specific SCI risk factors. Standard laboratory examinations focussed on examination of infection, anaemia, electrolytes, kidney and liver function and nutrition profile [36, 39]. Administration of the Spinal Cord Nutrition Tool (SNST) to detect nutrition deficiencies.…”

“…Closure of PI with tension free fascio-cutane tissue without scars over bony prominences if possible. Established flap techniques for different regions: os ischium—posterior thigh flap, os sacrum/coccygis—gluteal rotation flap, os trochanter—tensor fasciae latae flap [5, 36]. Diagnosis of osteomyelitis: performed through bone biopsies during the surgical debridement or during flap surgery.…”

“…Diagnosis of osteomyelitis: performed through bone biopsies during the surgical debridement or during flap surgery. Infection treatment with specified antibiotics, duration approximately 6–8 weeks [36]. According to the diagnoses of osteomyelitis, postsurgical bed rest for 4–6 weeks [14].…”

“…PIs are classified according to the National Pressure Ulcer Advisory Panel in six degrees of severity (°III = full thickness tissue loss, °IV = full thickness tissue loss with exposed bone, tendon or muscle) [10]. With an increasing knowledge about the physiology and risk profiles in the development of PI stage III or IV [10–12] and short and long-term effects of different medical and surgical treatments [13], recommendations including different treatment elements came up [2, 5, 6, 14]. These concepts include preconditioning of the PI with pressure relief, highly specialised surgery procedures with different flap techniques and complex inter-professional interventions including nursing, nutrition and psychotherapy, physiotherapy and occupational therapy [15–17].…”