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Short note on Pressure sore. [TU 2065/5,64/5,63/12]
Pressure ulcer is an area of localized damage to the skin and/or underlying tissue, usually over a bony prominence (figure 1), as a result of pressure, or pressure in combination with shear (eg, sacrum, calcaneus, ischium)
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Pathophysiology of pressure sore?
Prolonged weight bearing, as in an immobilized or paralyzed patient, can elevate tissue pressure above arterial capillary perfusion pressure (32 mm Hg) and result in compromised oxygenation, ischemia, and eventual tissue necrosis.
The clinical sequelae of this damage are pressure sores with ulceration, infection, and exposure of bone. In order of occurrence, the surfaces most commonly involved are those over the sacrum, calcaneus, ischium, and greater trochanter
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NPUAP staging of pressure sore?
The National Pressure Ulcer Advisory Panel (NPUAP) staging system
- Stage 1 - intact skin with a localized area of nonblanchable erythema
- Stage 2 - partial-thickness loss of skin with exposed dermis
- Stage 3 - full-thickness loss of skin, adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present
- Stage 4 - full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer
Unstageable - when there is full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
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Treatment of pressure sore?
- Pain control
- Infection control
- Optimize nutrition
- Redistribute pressure
- Adjunctive therapies – Negative pressure wound therapy, Hyperbaric oxygen therapy
- Stage 1 - covered with transparent film for protection
- Stage II – dressing that maintains moist wound environment, generally require little debridement
- Stage 3 and 4 - debridement and coverage with appropriate dressings, treatment of infection
- Surgical Managment -
- Skin graft for a clean, healthy recipient site, with good blood supply and no exposed bone.
- Flaps - cutaneous, fasciocutaneous, musculocutaneous, muscle-only, and free microvascular
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Diabetic foot. [TU 2068/2]
Wagner's classification of diabetic foot?
Grade 0 - Foot symptoms like pain,only
Grade 1 - Superficial ulcers
Grade 2 - Deep ulcers
Grade 3 - Ulcer with bone involvement
Grade 4 - Forefoot gangrene
Grade 5 - Full foot gangrene
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