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  4. A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury

A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2020 · DOI: 10.46292/sci2603-177 · Published: July 1, 2020

Spinal Cord InjuryHealthcareDermatology

Simple Explanation

Skin breakdown, including burns and pressure injuries (PrIs), are devastating complications of SCI. Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized.

Study Duration
Not specified
Participants
Not specified
Evidence Level
Not specified

Key Findings

  • 1
    Skin breakdown is often caused by multiple factors and requires PCPs to familiarize themselves with the individual’s overall health, mobility, and social support.
  • 2
    The cornerstone for skin breakdown prevention in persons with SCI is education that takes into account the individual’s preferences and life goals.
  • 3
    Acute and chronic osteomyelitis may contribute to nonhealing of stage 4 PrIs and has been found in 25%-47% of nonhealing severe PrIs.

Research Summary

Skin breakdown, including burns and pressure injuries (PrIs), are devastating complications of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. The successful prevention and treatment of wounds in people with SCI requires an interdisciplinary approach in order to minimize risk factors, remove identifiable causes, and promote wound healing.

Practical Implications

Comprehensive Skin Exams

Perform full skin exams annually for early detection.

Interdisciplinary Team

Involve specialists for impaired mobility and sensation.

Durable Medical Equipment Assessment

Assess wheelchair cushions and mattresses for suitability.

Study Limitations

  • 1
    Reliance on interdisciplinary approach may be limited by resource availability.
  • 2
    Palliative care may be needed for chronic wounds.
  • 3
    Risk assessment tools may not capture all contributing factors.

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