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Decubitus Ulcer 707.0

 
  • synonyms: Pressure ulcer, bed sore, decubitus ulcer, plaster ulcer
  • ICD-9 = 707.0 (Pressure ulcer, bed sore, decubitus ulcer, plaster ulcer)
  • see emedicine.com discussion
  • Tissue ischemia and eventual ulceration and tissue loss resulting from prolonged exposure to pressures exceeding capillary filling pressure, approximately 32 mm Hg.
  • Risk Factors: restraints, neurologic impairment, heavy sedation, dementia, contractures, hospitalization, elderly
  • Most common: ischial tuberosity, trochanteric, and sacral. Other common locations: malleolar, heel, patellar, pretibial.

Prevention

  • Eliminate pressure.
  • Specialized beds: low-airloss (Flexicair, KinAir), air-fluidized (Clinitron, FluidAir).
  •  Repositioning every 2 hours
  • Keep wound / skin clean and free of urine and feces. (bowel and bladder regimen)
  • Nutritional supplementation: Restore positive nitrogen balance and serum protein level of 6 mg per 100 mL

Classification / Treatment

  • National Pressure Ulcer Advisory Panelclassification system.
  • Stage I: intact skin with signs of impending ulceration. Blanchable erythema from reactive hyperemia, may have warmth and induration or skin may appear white from ischemia. Treatment = prevention
  • Stage II: partial-thickness loss of skin involving epidermis and possibly dermis. May appear as an abrasion, blister, or superficial ulceration. Treatment = hydrocolloid occlusive dressing (DuoDerm),
  • Stage III: full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. Looks like a crater with or without undermining of adjacent tissue. Treatment = wet-to-dry dressings, incorporating isotonic sodium chloride solution or dilute Dakins solution (sodium hypochlorite), Silvadene, Sulfamylon, hydrogels (Carrington gel), xerogels (Sorbsan), and vacuum-assisted closure (VAC) sponges. Consider daily whirlpool use to irrigate and mechanically debride the wound.
  • Stage IV: full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Treatment = wet-to-dry dressings, incorporating isotonic sodium chloride solution or dilute Dakins solution (sodium hypochlorite), Silvadene, Sulfamylon, hydrogels (Carrington gel), xerogels (Sorbsan), and vacuum-assisted closure (VAC) sponges. Consider daily whirlpool use to irrigate and mechanically debride the wound.
  • Debridement indicated for severely contaminated wounds with necrotic material.

Pressure Sore Complication

  • recurrence
  • sepsis
  • myonecrosis
  • necrotizing fasciitis
  • gangrene
  • malignant degeneration (Marjolin ulceration; typically highly aggressive squamous cell carcinomas )

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