PRESSURE SORES-BED SORES

What is a pressure sore/bed sore and who is a good candidate for an operation?

Pressure sores or else bed sores are localized areas of tissue necrosis that tend to occur when soft tissue (skin, fat, muscles) is compressed between a bony prominence and an external surface for prolonged periods of time. Bed sores are generally developed in bedridden patients.

The main factors that cause and worsen pressure sores, are the following:

• pressure on the area (non-frequent change of patient’s body positioning)
• friction forces
• abrasion, wound infection
• moisture, wound maceration
• patients with malnutrition

The treatment of pressure sores is divided into conservative and surgical. Stage 1 and Stage 2 pressure sores (that have not affected the viability of underlying muscles) usually are treated conservatively. Stage 3 and Stage 4 pressure sores, with muscle necrosis or necrosis of the underlying bone are treated surgically, as long as the patient is stable, has a supportive home environment or there is likelihood of full recovery.

Dr Karmiris will explain you in detail the complexity of specific operations, will answer all your questions and will recommend you the most suitable treatment.

What to expect at your first appointment?

At your first appointment, you will discuss:

• defect size, medical history of the specific pressure sore, patient’s mobilization in the future as well as the need for supportive home environment post operatively.
• the remaining medical history, if you are on any medication, vitamins or other herbal supplements, if you have any allergies or any other operations in the past

• if you smoke (if the answer is yes, how many cigarettes per day).

Afterwards, Dr Karmiris:

• will evaluate your general health condition and any other risk factors

• will examine you and will take all the detailed measurements regarding your pressure sore, the condition of the surrounding tissues and will exclude the likelihood of active infection

• will take preoperative photographs
• will discuss with you all the possible surgical options, depending on your case
• will discuss with you all the possible results of the surgical procedure and any risks or potential complications, as described in the international literature

• will discuss with you about the anaesthetic plan.

Preoperative Check:

Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.

Also, it will be necessary to stop smoking preoperatively, and immediately post-op as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.

The surgical procedure:

Most of the operations are performed under General or Epidural Anaesthesia. After extensive surgical cleaning of the lesion that may include removal of skin, muscles or even necrosis and infection of bone spur (chronic osteomyelitis), reconstruction and closure of defect is performed. This is done either by using tissues transferred from adjacent areas (local flaps), or even by transferring tissues from one part of the patient’s body to another by using microscope (free flaps). The final decision for reconstruction is related not only to the clinical condition of the patient, but also to the pressure point and the risk assessment scale.

Post operatively:

Immediately after the surgical procedure, you will have medical gauze or bandages on the incisions which will be reduced, gradually. If drains have been used, they will not be removed in less than a few weeks. For example, in pressure sores on the sacrococcygeal region, drains will be removed after 3 weeks, post operatively.

Extremely important in patient’s post-operative follow up is the supportive home environment. The patient will need a permanent caregiver in order to change patient’s body positioning. If the aforementioned conditions are met, patients can be discharged within 3-7 days, depending on the case. Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op, what medication you should take and when you will be seen for a follow up.

For more information regarding pressure sore reconstruction, book today your appointment with Dr Nikos Karmiris.

The doctor will answer all the questions and will help you to find the most appropriate therapy, depending on your case.