PRESSURE SOREPrepared by:Dr.mohammed abd alhussein laftahResident of plastic and reconstructive surgery

Pressure sore

Definition: soft tissue injury caused by unrelieved pressure over bony prominence

Pressure sore

Staging: Stage 1: erythema persist more than 1 hr. after

pressure relief. Stage 2:blister or other break in the dermis with or

without infection. Stage 3:subcutaneous destruction into the muscle

with or without infection. Stage 4: involvement of bone or joint with or

without infection. Unstageable Full thickness tissue loss in which the base of the

ulcer is covered by slough and/or eschar.

Pressure sore

Stage I

Pressure sore

Stage II

Pressure sore

Stage III

Pressure sore

Stage III

Pressure sore

Unstagable

Pressure sore

Unstagable

Pressure sore

Pressure Areas

Pressure sore

Pressure sore

Pressure sore

Incidence in hospitalized patient about 9%.Risk factors: Aging Male gender Sensory impairment Moisture Immobility Malnourishment Friction shear force.

Pressure sore

Factor accelerate bed sore progression:

Infection Inflammation Edema

Pressure sore

Preoperative care: Nutritional status assessment Control of local and systemic

infection. Pressure and spasm relief.

Pressure sore

Surgical treatment: Debridement Ostectomy Pressure sore closure.

Pressure sore

Ischial defects: High recurrence rate Methods: Medially based thigh flap Gluteus maximus muscle flap. Gluteu maximus myocutaneous flap V-y advancement flap Gluteal Iceland thigh flap Tensor fascia lata thigh flap Graclis flap

Pressure sore

Sacral defect: Musculocutaneous flap Fasciocutaneous flap’Trochanteric defect: Tensor fascia lata flap.

Pressure sore

Postoperative care: Nutrition Medical control (d.m. ,ht. ,spasm) Nursing care. Turn over every 2 hrs. Broad spectrum ab. Sphincter control.

Pressure sore

Carcinoma: The most common is sequamous cell carcinoma

and can compare it to carcinoma raised in burn scar:

Its more aggressive Metastatic rate is higher 61% compared to 34%. Time interval of development is reduced 25 y

compared to 30 y in burn related carcinoma. Wide surgical excision to clear margins is

recommended prophylactic lymph node dissection is not recommended but indicated if clinically involved.