Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - xiii

CLINICAL PRACTICE GUIDELINE



Use the following mechanical wound
cleansing techniques to remove wound
debris, exudates, surface pathogens,
bacteria, and residue from topical creams
and ointments.
* 4-15 pounds per square inch (psi)
pressure irrigation with angiocatheter
attached to syringe, spray bottle, or
pulsatile lavage.
* Gentle scrubbing of the wound bed with
wet gauze.



Cleanse periwound skin with normal saline,
sterile water, pH-balanced skin cleanser,
or lukewarm potable tap water with
dressing changes.

D E B R I D E M E NT

15. Debride devitalized tissue using a method or a
combination of debridement methods appropriate
to the ulcer's status.


Debride eschar and devitalized tissue with
the exception of a stable heel eschar.



Debride areas in which there is unstable
eschar and devitalized tissue.



Abnormal wound healing



Nutrition



Medication



Support surfaces



Transfers



Noncompliance

Surgery for Pressure Ulcers
REFERRAL F OR PRESSURE UL CER SURGERY

19. Refer individuals with deep category/stage III and
category/stage IV pressure ulcers for operative
intervention. For persons deemed appropriate
candidates for surgical reconstruction, adhere to
the following tenets of surgical treatment:


Reverse any pressure ulcer risk factor if
possible (e.g., impaired nutritional status)
and address pre-op medical risk.



Prior to surgery, treat osteomyelitis or
cellulitis. This may need to be combined with
excision of infected bone during surgery.



Fill dead space and enhance the blood
supply of the healing wound by mobilizing
well-vascularized soft tissues flaps.



Contour bony prominences to yield larger,
flatter surfaces to augment pressure
distribution.



Reconstruct soft tissue defects with large
regional pedicle flaps, placing suture lines as
far away from the area of direct pressure as
possible and with minimum tension. Avoid
encroaching on adjacent flap territories.



Preserve options for future potential
breakdowns.

S E L E C T I O N OF W OUND CA RE DRE S S ING

16. Use a dressing that achieves a physiologic local
wound environment that maintains an appropriate
level of moisture in the wound bed:


Control exudate



Eliminate dead space



Control odor



Eliminate or minimize pain



Protect the wound and the periwound skin



Remove nonviable tissue



Prevent and manage infection

E L E C T R I C A L S T IMULAT ION

17. Use electrical stimulation (ES) to promote closure
of category/stage III or IV pressure ulcers, unless
contraindicated in the cases of untreated,
underlying osteomyelitis or infection.
O N G O I N G M ONIT ORING A ND MODIFICAT ION OF
T R E AT M E N T PLA N

18. Modify the treatment plan if the ulcer shows no
evidence of healing within 2 to 4 weeks. Review
individual factors associated with non-healing of
pressure ulcers, such as the following:

PREOPERATI VE ASSESSMENT

20. Address the following factors to enhance the
effectiveness of pressure ulcer surgery:


Presence of osteomyelitis



Wound bioburden



Nutritional status



Bowel and Bladder management



Spasticity and contracture



Heterotopic ossification



Comorbid medical conditions



Anesthesia



Incontinence



Previous ulcer surgery



Infection



Smoking Cessation



Carcinoma



Urinary tract infection

xiii
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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