DECUBITUS ULCER

By:
Dahniar Rizki Fahriani (G99152044)
Darma Aulia H (G99152037)
Katherine Gowary S (g99152032)
Nurul Fadilah (G99162083)
Yasfie Asykarie (G99161110)

Supervisor:
Amru Sungkar, dr.,Sp.B,Sp. BP-RE
LITERATURE REVIEW
 DEFINITION

Pressure Sore : damage caused to the skin due to compression or irritation of time
at a location where there are bony, causing obstructed blood flow that can occur
local ischemia and necrosis

(Crowe T & Brockbank C,2009).

(Wong H, et.al,2015).
(Grey et.al,2006).
 MORBIDITY AND MORTALITY

Morbidity and mortality of patients with pressure sore

will be increased in patients who experience
complications such as infection.

The most common complication in patients

with pressure sore was infection

(Kumar A, Mahal R,2014).

 ETIOLOGY

The main caused of pressure sore is the pressure which causes ischemia.

(Garber SL, Rintala DH ,2003).

 RISK FACTOR

Uncontrolled Neurovascular
Old age
diabetes disease

Spinal damage Malnutrition Trauma

(Apostolopoulou E, et.al ,2014)

PATHOPHYSIOLOGY

(Grey et.al,2006).
 PATHOGENESIS
Interface Pressure
leads to decreased capillary blood flow, occlusion of blood
vessels and lymphatic vessels, and tissue ischaemia.
Shear
generated by the motion of bone and subcutaneous tissue
relative to the skin, which is restrained from moving due to
frictional forces
Friction
lead to the formation of intraepidermal blisters

Moisture
causes maceration of the surrounding skin

(Grey et.al,2006).
 SYMPTOM
NPUAP classified pressure sore into four grades.

GRADE I GRADE I

limited to the epidermis and dermis with

erythema of the skin
can be cured in 5-10 days.

(Dharmarajan T.S, Ugalino J.T ,2002)

 GRADE II
GRADE II
extending into adipose tissue
visible erythema and induration
can be cured in 10-15 days

(Dharmarajan T.S, Ugalino J.T ,2002)

GRADE III GRADE III

extending to the subcutaneous

fat layer and muscle
usually heal in 3-8 weeks

(Dharmarajan T.S, Ugalino J.T ,2002)

GRADE IV GRADE IV

ulceration and necrosis extends

the fascia, muscles, bones and
joints
can occur or osteomyelitis and
septic arthritis
can be recovered in 3-6 months.

(Dharmarajan T.S, Ugalino J.T ,2002)

 EXAMINATION

Culture and urine

Stool cultures Biopsy
analysis

Blood check Nutrition condition Radiology

(Niezgoda JA, et.al,2006)

 TREATMENT

Things to consider when treat pressure sore:

Wound treatment should be differentiated into operative methods and

nonoperative.

Wound treatment methods nonoperatif done for pressure sore grade 1

and 2, while for grade 3 and 4 shall use the operative method.

Approximately 70-90% of pressure sore are superficial and heal by

secondary healing.

Reduce further pressure on the ulcer area.

(Riordan J, Voegeli D,2009)

PRESSURE SORE TREATMENT CAN BE DIVIDED AS:

(Riordan J, Voegeli D,2009)

NON SURGICAL TREATMENT

Medical
Diet
Rehabilitation
Position Drugs
a diet that is Infrared therapy Repositioning Antibiotics
high in calories, Short wave every 2 hours
protein, diathermy to the right
vitamins and
minerals and left

(Riordan J, Voegeli D,2009)

Maintaining a clean state

Lowering and overcome the infection

Stimulate and help the granulation

tissue formation and epithelialization

(Riordan J, Voegeli D,2009)

MAINTAINING A CLEAN STATE

Foams Alginates Gauzes

Transparent
Hydrocolloids Hydrogels
films

Wound fillers Wound pouches

(Riordan J, Voegeli D,2009)

LOWERING AND OVERCOME THE INFECTION

Antibiotic

Antiseptic

UV radiation

(Riordan J, Voegeli D,2009)

LOWERING AND OVERCOME THE INFECTION

Topical zalf

Hyperbaric O2

(Riordan J, Voegeli D,2009)

SURGICAL TREATMENT

LIFTING OF NECROTIC TISSUE

(Riordan J, Voegeli D,2009)

 LIFTING OF NECROTIC TISSUE

Ultrasound assisted
Biological debridement Sharp debridement
debridement

(Riordan J, Voegeli D,2009)

 SURGERY
All of the pressure sore should be excised as a
pseudotumour.

The underlying bone should be removed as a

recontouring ostectomy

Either muscle or subcutaneous fat with fascia should

be used to pad the bony stump and fill the dead space

The area of pressure should be resurfaced with a large

flap ofhealthy skin
(Riordan J, Voegeli D,2009)
 SURGERY

as large as possible, with the suture line lying

away from the area of direct pressure
The flap should be : designed so that it does not interfere with the
design of other local flaps that may be needed
if the wound breaks down or recurs.

(Riordan J, Voegeli D,2009)

 SPECIFIC AREAS -ISCHIAL

a fasciocutaneous flap the inferior gluteus

the gluteal thigh flap maximus myocutaneous
based on the descending
branch of the inferior flap
gluteal artery
(Mostafa,2012)
SPECIFIC AREAS-SACRAL

Gluteus maximus
musculocutaneous V-Y gluteus
flap maximus flap

Gluteal rotation
flap
Superior gluteal
artery island flap

(Diaz et all,2013)
 SPECIFIC AREAS-TROCHANTERIC

Tensor Fascia Lata (TFL) musculocutaneous

anterolateral thigh flap
flap

(Diaz et all,2013)
 PREVENTIF

Repositioning in a
Skin care Nutrition
bed

Quit smoking Stay active

(Diaz et all,2013)
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THANK YOU