Palestinian Experience in Stage Four Pressure Ulcer

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

Isolated Volar Distal Radioulnar Joint Dislocation, a Very Rare and Easily Missed Injury.

Background: Isolated distal radioulnar joint (DRUJ) dislocations without associated fracture are very rare entities. A few mechanisms of injury were reported in the literature with dorsal(posterior) dislocation being more common than the volar (palmar, anterior) dislocation. Case report: A 26-year-old male, manual laborer presented to our emergency department (ED) 24 hours post-self-inflected injury with right wrist pain, deformity, and decreased range of motion (ROM). The physical examination showed bruising over the dorsal ulnar side of the wrist, loss of the ulnar styloid bony prominence, abnormal volar fullness of the wrist, and gutter deformity on the dorsal aspect of the distal forearm and wrist. The diagnosis was confirmed by comparative radiographs which were followed by closed reduction and immobilization in the below-elbow cast in pronation for 4 weeks. Conclusion: Timely accurate diagnosis and conservative treatment with favorable outcome necessitate a proper history on the mechanism of injury with a thorough physical examination, accurate radiographic positioning, and true lateral view.

Primary cam morphology; bump, burden or bog-standard? A concept analysis

BackgroundCam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology.DesignWe conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex ‘concepts’; the end product is a precise definition that supports the theoretical basis of the chosen concept.ResultsWe propose five defining attributes of primary cam morphology—tissue type, size, site, shape and ownership—in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised.ConclusionWe introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape—a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.

The Gluteus Maximus V-Y Advancement Flap for Reconstruction of Latero-sacral Pressure Injury

Pressure Injuries (PIs) are described as “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear [1]. The pathology remains frequent in hospital settings despite the progress made in prevention which represents the optimal management of this pathology [2]. Clinically, they can cause severe pain, serious physical and psychological discomfort often leading to prolonged hospitalization and poor quality of life in the daily clinical practice [3-6].

Bedsore and strategies for preventing and treating the bedsore

The best recognized and also the most widespread example of tissue necrosis is bedsore. A bedsore is localized damage to the skin and other underlying tissue, usually over a bony prominence, as a result of prolonged, unrelieved pressure. The cause of bedsore is shearing forces; friction, moisture, and constant pressure contribute to the development of bedsore. Hospital research shows that bedsores develop from 3% to 4.5% of patients during prolonged hospitalization and Sores develop from 25% to 85% of patients with spinal cord injury. The doctor and nurses will regularly examine the patient who is at risk of developing bedsore and inspect each pressure sites at least twice a day. Doctors and nurses are important warriors who manage bedsore treatment effectively. This review describes the new strategies have been used to prevent and management of bedsore such as inexpensive foam devices, anti-pressure devices, air-filled equipment, a sheet of hydrogels, wound vacuum-assisted closer, skin bioprinting, and Lab VIEW virtual instrument.

Katupila (Securinega leucopyrus) A Boon for Bedsore- A Case Report

Pressure ulcer is a sequel of tissue necrosis and ulceration due to prolonged pressure. External pressure of more than 30 mmHg on the skin leads to ischemia (reduced blood flow) causing ischeohypoxia, necrosis and ulceration. It is more common between bony prominence and an external surface. It may be due to impaired blood supply, defective nutrition and neurological deficit. Ayurveda describes this type of non-healing ulcer in terms of <em>Dusta vrana</em>, in that context <em>Acharya Sushruta</em> had also mentioned it as “<em>Dirghakalanubandhi</em>” which suggests that these kind of ulcers take longer time to heal due to underlying reasons. This article is about the single case report of a 51-year-old male patient with a stage 3 decubitus ulcer over the right heel since 2 months. As decubitus ulcers especially of stage 3 is difficult to cure, ayurvedic management with internal medication and external therapy was performed in this reported case. For Internal medication, Tablet septilin (A Patent medicine of Himalaya pharmacy, India) and <em>Punarnavadi kashay</em> (A Patent medicine of Vaidhyaratnam pharmacy, India) was used for enhancement of better wound healing. For external application Paste Katupila and honey was applied for 30 days. According to the assessment, wound showed good response within 10 days and was completely healed in 30 days.

Socioeconomic effects of pressure ulcer

A pressure ulcer is defined as localized ischemic skin or soft tissue damage resulting from disruption of the blood supply by pressure over the bony prominence. However, it is not just a wound that causes pain to individuals, but also a complex disease that causes socioeconomic losses. In 2019, total 30,983 patients with pressure ulcers were treated at medical institutions in Korea, and 76 billion Korean won (KRW) was spent on this treatment. Inpatient care cost amounted to 65.5 billion KRW, whereas outpatient care cost amounted to 9.8 billion KRW. The average hospitalization cost per patient was 6,696,605 KRW, and the average hospitalization period was 57.4 days, averaging 116,707 KRW per patient per day. The average outpatient care cost per patient was 421,134 KRW, and the average period in the clinic was 8.9 days, calculated at 47,428 KRW per day. The development of pressure ulcers inevitably causes socioeconomic losses and puts strain on limited medical resources; therefore, the best socioeconomic solution is prevention. Prevention has been shown to be much more efficient in cost-effective studies on treatment and prevention. Therefore, investment of more resources to prevent the development of pressure ulcers is the best solution to reduce the related socioeconomic burden.

Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

Treatment of a Chronic, Nonhealing Neuropathic Ulcer in a Pediatric Patient With Spinal Dysraphism: A Case Report

A neuropathic ulcer results from repetitive trauma to a hyposensitive distal extremity, usually on a weight-bearing bony prominence. In addition to neuropathy, deformities and adapted walking patterns increase the risk of these wounds in children with spinal dysraphism. Information about treatment strategies for these wounds is limited. PURPOSE: The purpose of this case study was to describe the management of a chronic, nonhealing neuropathic ulcer on the dorsum of the left foot of an 11-year-old boy with spinal dysraphism. METHODS: Autologous platelet-rich plasma (PRP), obtained using a double centrifuge technique, was applied weekly underneath a nonadherent dressing and a below-knee plaster of paris cast. Complete non–weight-bearing was encouraged. RESULTS: The patient presented with a 9 cm2 wound and a Pressure Ulcer Scale for Healing (PUSH 3.0) score of 13, which was of 6 months’ duration. For the first 3 weeks, the autologous PRP and plaster cast were applied weekly. After 3 weeks, the wound was 2.25 cm2 (PUSH score 7) and treatment was changed to moistened saline dressings underneath the cast. The wound was healed after 5 weeks. No adverse effects were observed. CONCLUSION: Studies are needed to evaluate the safety and effectiveness of autologous PRP in neuropathic ulcer management in pediatric populations and to obtain evidence for optimal management of these wounds in persons with spinal dysraphism.