Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

The Journal of Spinal Cord Medicine, 2013 · DOI: 10.1179/2045772313Y.0000000093 · Published: November 1, 2013

Simple Explanation

Pressure ulcers are a major concern for individuals with spinal cord injuries, leading to frequent hospital readmissions and potential complications. Effective management requires a team approach and depends on the patient's understanding of prevention and treatment. This article reviews current and future methods for treating these ulcers. Pressure ulcers can lead to many issues including recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They also present a significant cost to the healthcare system. The review covers pressure ulcer epidemiology, cost, research history, etiology, staging, factors influencing wound healing, local wound care, surgical treatments, and future trends in wound healing research and medical technology.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Pressure ulcers in SCI patients are often located on the ischium, sacrum, trochanter, and heel, occurring when external pressure exceeds capillary pressure. Tissue injury is linked to extrinsic factors like pressure and intrinsic factors like sepsis.
2
Effective pressure ulcer management involves identifying and correcting risk factors, consistent documentation, and proper clinical staging of the wound. Consistent measuring methods are essential to proper documentation.
3
The three major phases of wound healing are inflammation, proliferation, and maturation, which are often impeded in pressure ulcers. Clinical management aims to stimulate physiologic wound healing with pressure relief and other methods.

Research Summary

Pressure ulcers are a significant challenge for SCI patients, leading to recurrent hospitalizations and high healthcare costs. Effective management requires a multidisciplinary approach, focusing on patient education, prevention, and adherence to treatment protocols. The review covers various aspects of pressure ulcer management, including epidemiology, etiology, staging, wound care, surgical treatments, and future research trends. Prevention is crucial, and hospital-acquired pressure ulcers are increasingly viewed as preventable and indicative of care quality. Future trends in wound care, such as cytokine growth factor therapy, cell-based therapies, and improved pressure-relieving technology, hold promise for enhancing pressure ulcer treatment. More research is needed to determine the cost-effectiveness and evidence-based improvements of these therapies.

Practical Implications

Clinical Practice

Healthcare professionals should regularly update their knowledge of pressure ulcer physiology and management due to the high risk faced by SCI patients.

Healthcare Policy

Institutions should prioritize pressure ulcer prevention as a quality of care indicator, given that hospital-acquired pressure ulcers are increasingly categorized as preventable.

Future Research

Further research is needed to evaluate the effectiveness and cost-efficiency of emerging wound care therapies for pressure ulcers.

Study Limitations

1
The review relies on existing literature, which may have limitations in study design or sample size.
2
The lack of research comparing support surfaces underscores the need for continued studies to define use and treatment guidelines.
3
Postoperative pressure ulcer complications, recurrence rates, and mortality rates in the published literature are largely retrospective or case series data.

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