View Full Version : Pressure Sore Treatment
08-26-2001, 04:49 PM
Ok folks. I've donned my flame retardant suit for any possible answers to this. A nurse friend told me that in the hospital where she works, they treat pressure sores by rubbing with milk of magnesia and then putting a heat lamp on it for 30-45 minutes several times a day. Does this make any sense to anyone? I thought I had read that they were supposed to be kept moist? As usual, I'm lost! Help!
08-26-2001, 08:38 PM
Has this nurse worked in the last 20 years? Both of these treatments are totally outdated, with no proven benefit and much potential harm!!! Rubbing a stage I is a perfect way to make it a stage II. There is no way that any topical treatment to unbroken skin can effect the deep tissues where the damage has already occured. Heat lamps are more likely to burn the person who lacks sensation, and do not improve healing. Exposing the open ulcer to the air and letting it dry (often with heat lamps) will also delay healing. Open ulcers should be kept covered and moist. This nurse is not a wound care expert, nor an expert in SCI, I would wager. (KLD)
08-26-2001, 08:48 PM
KLD, I knew I had to have your opinion before I tried that! It just didn't sound right to me. And you're right -- she has been retired for several years. It was starting to look better after 3 days in bed alternating from side to side, but he talked me into letting him sit up yesterday and last night it was worse again. Now in addition to the red rings circling the yellowish skin, there is a dark blue/black mark about 1" x 1/4". Is it time for the doctor?
As always, thanks!
08-27-2001, 04:34 PM
Martha, at all cost stay on top of that sore. I am a paraplegic and I spent 2 and a half months in the hospital and another 3 weeks in bed because of requiring surgery on a sore that went totally bad.
Progessed well past stage 3 and infected the bone. I have been back up for less than a month and I am going back to bed for wound care on the same area,,,, no matter what we did, it went bad again.
If it is stage 1 stay off of it for several days, I know that is hard but you don't want surgery to be an option. Spinal Nurse is right about stage 2, Normal Saline and sterile gauze changed at a minimum of twice a day.
Do not use any topical gels or antibiotics unless instructed to by a "Wound Care Specialist", not a family Doctor. Only time a SCI'd individual should see a family Doctor is if they have a cold, a mild UTI, or for HMO reasons needs a referal to a specialist.
In 4 years of being in a wheelchair I have only had one pressure sore,,, that sore just happen to be "The Mother of All Sores".
08-27-2001, 04:50 PM
Max, Thanks for the heads-up. I think we've been screwing up all the way around. At first, he swore it was a spot of psoriassis (sp) breaking out, so we dabbed on the triamcinalone. Then it started looking "different" so I tried the bacitracin. For the last couple of days I've just done nothing but try to keep him off of it. Guess we'll continue to go that route as long as I can keep him down and see what happens from here. http://sci.rutgers.edu/forum/images/smilies/frown.gif
08-27-2001, 08:44 PM
As my spinal cord Dr. says, " it's not what you put on them, it's what you take off (pressure) ".
08-29-2001, 03:48 PM
From working with my son for 5 yrs.the key is to get the pressure off. A few weeks up front is better than months later on. We have also tried the following on 2 occasions and had very good success both times. Our neighbor, a surgeon who worked several years in a VA hospital was impressed with how fast and how well our recovery was. Remeber get off and stay of the area. Our home remedy is Aloe Vera, I buy an Aloe Vera plant at the local Fred Myers strip the inner skin off leaving the jellied inside and outer skin intact, I apply this piece ( jelly side down) which is big enough to cover the spot with a single strip of medical tape. I leave it on for 12 hrs. then remove and leave uncovered for 12 hrs. Using a new piece each time. Once on the road to recovery I reduce the aloe vera time and apply a small amount of ointment. cheers
08-31-2001, 02:03 PM
When I had the problem, I put on a topical anti biotic ointment every day, twice a day. My goal was to prevent the possibility of infection. I also did electrical stimulation of my gluts twice a day for a month. I do it once a day now.
08-31-2001, 06:32 PM
I have had a brutal bout with pressure sores.the main thing i found is to relieve all preesure around the sore.i had to have skin grafts that didn't take the first time and almost had to have an amputation of both legs below the knee's.the second graft took but not completly,so i change dressings once a day.i use a silver sulfadiazine cream but you will need a perscription to get it.
good luck steve
08-31-2001, 07:28 PM
Everyone -- thanks for your education and encouragement. We had to run to the hospital last night for a different problem, but while there I asked about the pressure sore. They used (and prescribed for home) Carrasyn V hydrogel Wound Dressing. Since this was a cardiac unit and not SCI related, I wanted to check if SciNurse thought this was the appropriate medicine or if anyone else has used this and their results. Thanks again!
08-31-2001, 09:12 PM
Hi Martha, When I've had pressure sores, I've used a dressing called "Allevyn "the stuff is awesome, it's like an absorbant soft foam, it is very expensive though, but highly worth it. Also if the sore was quite deep I would use "Hydrogel, it's a gel made specifically for pressure sores, it also is really fantastic stuff. Both of these items were recomended by homecare nurses who deal with this problem all the time, they know there stuff alright. Oh yeah and of course the most important thing of course is Stay Off It!(sorry,I know it sucks, but ya gotta do what ya gotta do)
09-01-2001, 11:15 AM
Hi, to eric and/or SCI nurse -
What is electric stim for pressure sores? I've seen it mentioned a couple of times now. Is it like the small stim units the OT's use for improving hand function?
How do we find out protocols for using it?
Thanks, everyone! http://sci.rutgers.edu/forum/images/smilies/confused.gif
09-01-2001, 03:54 PM
Marmalady, several studies have shown that pulsed electromagnetic fields (Diapulse) may accelerate healing of decubiti. I threw in a couple of other abstracts of studies using electrical stimulation as well. Wise.
• Comorosan S, Vasilco R, Arghiropol M, Paslaru L, Jieanu V and Stelea S (1993). The effect of diapulse therapy on the healing of decubitus ulcer. Rom J Physiol. 30 (1-2): 41-5. Summary: The effect of pulsed high peak power electromagnetic field (Diapulse) on treatment of pressure ulcers is under investigation. 20 elderly patients, aged from 60 to 84, hospitalized with chronic conditions and bearing long-standing pressure ulcers, are subjected to Diapulse sessions (1-2 daily), parallel to conventional treatment. 5 patients undergo conventional therapy, serving as control and 5 others follow conventional+placebo Diapulse treatment. All patients were daily monitored, concerning their clinical status and ulcers' healing. After a maximum 2-weeks treatment, bulge healing rate was, as follows: 85% excellent and 15% very good healing under Diapulse therapy; in the placebo group, 80% patients show no improvement and 20% poor improvement; in the control group, 60% patients show no improvement and 40% poor improvement of ulcers. This investigation strongly advises for Diapulse treatment as a modern, uninvasive therapy of great efficiency and low social costs in resolving a serious, widespread medical problem. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=7982015> Interdisciplinary Research Group, Fundeni Hospital, Bucharest, Romania.
• Itoh M, Montemayor JS, Jr., Matsumoto E, Eason A, Lee MH and Folk FS (1991). Accelerated wound healing of pressure ulcers by pulsed high peak power electromagnetic energy (Diapulse). Decubitus. 4 (1): 24-5, 29-34. Summary: The purpose of this study was to evaluate the effect of pulsed high- frequency, high peak power electromagnetic energy (Diapulse) in the healing of pressure ulcers. Patients with Stage II ulcers unhealed within three to 12 weeks and those with Stage III ulcers unhealed within eight to 168 weeks by conventional methods were included in the study. When Diapulse was added to conventional therapy during the nine- month study, all 22 patients healed as evidenced by photographs and measurements of the ulcers. Stage II ulcers healed in one to six weeks (mean 2.33) and all Stage III ulcers healed in one to 22 weeks (mean 8.85). The increased healing time can provide significant cost savings and improved patient care. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=1994961>
• Cullum N, Nelson EA, Flemming K and Sheldon T (2001). Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 5 (9): 1-221. Summary: BACKGROUND: Chronic wounds such as leg ulcers, diabetic foot ulcers and pressure sores are common in both acute and community healthcare settings. The prevention and treatment of these wounds involves many strategies: pressure-relieving beds, mattresses and cushions are universally used as measures for the prevention and treatment of pressure sores; compression therapy in a variety of forms is widely used for venous leg ulcer prevention and treatment; and a whole range of therapies involving laser, ultrasound and electricity is also applied to chronic wounds. This report covers the final three reviews from a series of seven. AIMS: To assess the clinical effectiveness and cost- effectiveness of: (1) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (2) compression therapy for the prevention and treatment of leg ulcers; (3) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were handsearched. An expert panel was also consulted. METHODS - STUDY SELECTION: Randomised controlled trials (RCTs) which evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. RESULTS - BEDS, MATTRESSES AND CUSHIONS FOR PRESSURE SORE PREVENTION AND TREATMENT: A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only two trials evaluated cushions, one evaluated the use of sheepskins, and two looked at turning beds/kinetic therapy. RESULTS - COMPRESSION FOR LEG ULCERS: A total of 24 trials reporting 26 comparisons were included (two of prevention and 24 of treatment strategies). RESULTS - LOW-LEVEL LASER THERAPY, THERAPEUTIC ULTRASOUND, ELECTROTHERAPY AND ELECTROMAGNETIC THERAPY: Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischaemic and diabetic ulcers, and chronic wounds generally) and five of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. CONCLUSIONS (1) Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggests that air-fluidised therapy may increase pressure sore healing rates. (2) Compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence. (3) There is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11368833
http://www.ncchta.org/execsumm/summ509.htm> Department of Health Studies, University of York, UK.
• Franek A, Franek E and Grzesik J (1999). [Electrically enhanced damaged tissues healing. Part II: direct and pulse current in soft tissue healing]. Pol Merkuriusz Lek. 7 (40): 198-201. Summary: Methodology of soft tissues wounds, ulcers and pressure sores healing with direct current is described by the authors. Results of clinical trials and animal experiments are represented, as well as technical and using data. Electrical properties of damaged tissues (e. i. skin battery, vascular-interstitial closed circuits etc.) and probable electrical healing mechanisms are discussed. Effects of electrical current on batteries are described. Inductive and capacitive coupling of electric and magnetic fields, and high voltage electrostimulation for enhance tissue healing are also described in the article. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10835915> Katedry i Zakladu Biofizyki Lekarskiej Slaskiej, Akademii medycznej.
• Salzberg CA, Cooper-Vastola SA, Perez F, Viehbeck MG and Byrne DW (1995). The effects of non-thermal pulsed electromagnetic energy on wound healing of pressure ulcers in spinal cord-injured patients: a randomized, double-blind study. Ostomy Wound Manage. 41 (3): 42-4, 46, 48 passim. Summary: The objective of this randomized, double-blind study was to determine if non-thermal pulsed electromagnetic energy treatment significantly increases the healing rate of pressure ulcers in patients with spinal cord injuries. Subjects included volunteers admitted to a Veteran's Administration Hospital in New York over a 2 year period and consisted of 30 male spinal cord-injured patients, 20 with Stage II and 10 with Stage III pressure ulcers. Subjects were given non-thermal pulsed high- frequency electromagnetic energy treatment for 30 minutes twice daily for 12 weeks or until healed. The percentage of pressure ulcers healed was measured at one week. Of the 20 patients with Stage II pressure ulcers, the active group had a significantly increased rate of healing with a greater percentage of the ulcer healed at one week than the control group. After controlling for the baseline status of the pressure ulcer, active treatment was independently associated with a significantly shorter median time to complete healing of the ulcer. Stage III pressure ulcers healed faster in the treatment group but the sample size was limited. For spinal cord-injured men with Stage II pressure ulcers, active non-thermal pulsed electromagnetic energy treatment significantly improved healing. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=7546114>
• Sheffet A, Cytryn AS and Louria DB (2000). Applying electric and electromagnetic energy as adjuvant treatment for pressure ulcers: a critical review. Ostomy Wound Manage. 46 (2): 28-33, 36-40, 42-4. Summary: Chronic pressure ulcers are a significant health problem especially in the aging population. National estimated annual treatment costs are in the billions of dollars. Only two treatment-related recommendations receive high ratings for reported experimental evidence of validity: Use of moist wound dressings and adjunctive electrotherapy for unresponsive Stage III and IV and recalcitrant Stage II ulcers. A critical literature review pertaining to electrotherapy reveals a myriad of electrical treatment modalities varying greatly in electric current type, strength, direction, frequency, waveform, and underlying voltage. However, few clinical trials pertaining to electrotherapy exist with almost all of them characterized by a small sample size leading to a biased group assignment with no possibility for stratification by ulcer stage, site, and other important factors. Power analysis shows that a sample size of at least 164 subjects is needed to permit cost-effectiveness evaluation with attention to critical variables. "Time to healing" is recommended as the treatment outcome measure to permit proper efficiency comparisons between the various treatment modalities and controls. These comparisons are crucial in a cost-conscious environment. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10745854> Department of Preventive Medicine and Community Health, Bronx VA Medical Center, NY, USA.
• Stefanovska A, Vodovnik L, Benko H and Turk R (1993). Treatment of chronic wounds by means of electric and electromagnetic fields. Part 2. Value of FES parameters for pressure sore treatment. Med Biol Eng Comput. 31 (3): 213-20. Summary: Subjects with spinal cord injury are often distressed by pressure sores, which usually appear after prolonged pressure (wheelchair, bed) across the soft tissue which has already lost sensibility and has diminished microcirculation. The healing ability and its dynamics depend on the state of the subject's overall health. Consequently, evaluation of a particular treatment requires careful consideration of as many as possible of the parameters relevant to healing and an adequate criterion for assessing the state of the pressure sore. Bearing in mind these two circumstances, the results of a multicentre clinical study are analysed. The aim of the study was to test two hypotheses: first that healing is faster when sores are also treated by electric currents (ECs) (in addition to conventional treatment); and secondly that there exist differences in the efficiency of the treatment if direct or low-frequency pulsed currents (FES parameters) are applied. The data analysed show that pressure sores are likely to heal twice as fast when treated with low-frequency pulsed currents. EC seems to improve the healing rate in cases where the natural healing mechanisms of the body are not sufficient (chronic wounds, older subjects). <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8412373> Faculty of Electrical & Computer Engineering, University of Ljubljana, Slovenia.
09-01-2001, 05:37 PM
Steve went to Galveston's UTMB Hyperbaric Oxygen Center . He was being treated for a brain injury. He also had sustained a SCI..as a result, while at TIRR he developed a pressure sore....but it healed totally during the HBO treatments
09-02-2001, 08:11 AM
FES: Functional electrical stimulation may prevent pressure sores by:
changing the pressure distribution in the seating area
changing the shape of the buttocks (Levine, et al 1990)
increasing muscle mass in patients without severe atrophy or lower motor neuron lesions
reducing pressure in the buttocks (Ferguson, et al 1992)
increasing the patient's resistance to pressure, which directly influences tissue oxygenation and prevents injury-induced hypoxemia below the level of the lesion, which may also predispose to pressure sore development (Mawson, et al 1993)
09-02-2001, 02:40 PM
Thanks, Eric, and Dr. Young, for the info on electric stim for pressure sores -I hope we never have another one, but I sure will keep this in our 'bag of tricks'! Also will let the docs we deal with in on it.
Thanks again! http://sci.rutgers.edu/forum/images/smilies/wink.gif
09-04-2001, 02:44 PM
Correct me if I'm wrong, but what I believe this link is saying, is that periodic FES of the gluts will help prevent pressure ulcers. It may help heal them as well. But our goal is not only to heal them, but also prevent them from ever coming back. We as a community cannot afford to be cooped up in bed for days because of a sore that will not heal.