Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 42

42

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Eliminate dead space
Wound cavities should be loosely filled. In
order to promote debridement closure and
healing, the sinus tracts or tunnels, if they are
large enough, can be filled with a single piece of
moistened gauze or ribbon. The material filling
the wound cavity should be easily retrieved.
Filling materials that can break up or separate
should not be used as they can break and
inadvertently left in the tunnel, making them a
foreign body and the source of infection that will
prevent healing and closure. Enough dressing
material should be used to ensure that the
dressing is in contact with the wound bed, but
not so tightly as to prevent effective granulation
of the wound base. Tissue damage may result if
wounds are filled too tightly, causing increased
pressure on the tissue in the wound bed
(Bergstrom et al., 1994). If there is a risk of
loss of dressing material within a cavity, a single
piece of dressing material should be used with
one end easily accessible for removal at the next
dressing change.
Control odor
Odor from a pressure ulcer may be a sign
of infection. Monitoring the wound for infection
and using the correct dressing for the specific
type of wound will help combat odor from the
pressure ulcer.
Protect the wound and the periwound skin
Individuals with SCI have fragile skin,
especially if they have had prior pressure ulcers.
It is important to consider the quality of the
dressing adhesive when the skin surrounding the
ulcer is fragile. Dressings with low adhesive or
no adhesive may be selected when the goal is
not to place an adhesive in contact with the
wound margins or surrounding skin. The term
"epidermal stripping" refers to the removal of
the epidermis by mechanical means (Wysocki
and Bryant, 1992). Epidermal stripping can be
prevented by recognition of fragile skin,
appropriate application and tape, avoidance of
unnecessary tape, and the use of skin sealant or
solid wafer skin barriers under the adhesive
(Wysocki and Bryant, 1992). Silicone-based
dressings may decrease the risk of skin stripping
caused by adhesive products. Wound dressings
have evolved it to address the issue of epidermal
stripping. A silicone bordered dressing differs
from adhesive bordered dressing. Silicone is
applied to and will only adhere to clean, dry,
and intact skin. It's use allows the health-care
provider to peel or lift the border to view the
wound bed. If the periwound skin is denuded,
it would be best to apply a hydrocolloid to the

periwound skin in order to promote healing and
any adhesive sheet, tape, etc. should be secured
directly to the hydrocolloid.
No scientific studies address the use of rectal
pouches or fecal management systems to contain
the stool and prevent fecal contamination of the
dressings and the wound. However, in clinical
practice, rectal pouches and fecal management
systems are used at times to contain the liquid
stool and to prevent fecal contamination of the
dressing and the wound. When using these
systems, extra care must be provided to avoid
the development of recto-anal ulceration or
autonomic dysreflexia caused by pressure from
the device.
Dressing Selection
Numerous dressing products have been
marketed in the last decades. Currently, some of
the dressing categories include transparent films,
hydrocolloids, hydrogels, foams, alginates, or
gauze dressings. A summary of these products
and their indications, advantages, disadvantages,
and considerations for use is presented in Table
1. In general, the clinical trials of these products
were conducted on individuals in nursing homes
or hospitals and not on individuals with SCI. It
should be noted that a choice of a dressing should
be dynamic in keeping with changing condition of
the wound. Some circumstances that may indicate
the need for a dressing change include discomfort
or the presence of pain; change in the extent of
edema, erythema, or skin temperature; seepage
of exudate through the dressing; or strong odor
from the dressing (Krasner, 1997).
Most wound dressings today are semiocclusive rather than occlusive. Semi-occlusive
dressings are designed to protect the wound
and periwound skin from microbial and physical
insult. They provide thermal insulation, odor
control, compression, and deliver antimicrobial
agents. Moisture retentive dressings consistently
retain moisture at the wound site by interfering
with the natural evaporative loss of moisture
vapor. Please see Table 1 for a detailed
description of currently used dressings.
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

Table of Contents for the Digital Edition of Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury
