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- synonyms: Pressure ulcer, bed sore, decubitus ulcer, plaster ulcer
Decubitus Ulcer ICD-10 Code
Decubitus 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.
Decubitus Ulcer 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
Decubitus Ulcer 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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