Because of legal restrictions, MOMSCIS cannot give specific medical advice. The following information is not a substitute for the personal care or advice of your physician. Please discuss any concerns with your physician regarding your medical care. Physicians in the Physical Medicine & Rehabilitation Department at the University of Missouri-Columbia are available to evaluate patient records, and can set up a clinic visit for a medical evaluation. The PM&R Department does extensive treatment of individuals with spinal cord injuries using a wide variety of physical therapies and state-of-the-art medications. Individuals with spinal cord injuries can be examined and treated on an outpatient or inpatient basis. For more information about the PM&R services available or to schedule a clinic visit, telephone the clinic at (573) 884-0033.

How to treat, prevent pressure sores

By Michael Acuff, M.D.
MOMSCIS Spinal Cord Injury Specialist

Q: I've developed a pressure sore, which is really causing problems. How do I treat it and how can I prevent them in the future?

A: For individuals with spinal cord injury, the loss of skin integrity is the most costly complication after injury. Surgeries and care that are associated with this complication can cost more than $100,000. Not only is the cost of skin breakdown a concern for health care providers and individuals with spinal injury, but the loss of functional capacity and independence is also a significant problem.

Because of this, a concerted approach should be taken to monitor skin integrity and maintain close surveillance and aggressive treatment of any skin breakdown condition. The areas that are at greatest risk for skin breakdown are areas of the skin that overlie hard bony areas such as the hip, buttock, ankle or heel as well as shoulder blade and spine processes in the back. These areas should be examined at least once a day, and if there is any sign of any compromise of skin integrity, the area should be examined more frequently than this.

If there is any sign of skin breakdown, the cause of the skin integrity problem must be determined. This could be the result of inappropriate pressure relief or cushioning, poor positioning, friction and rubbing, or moisture and soiling of the skin.

Once the cause has been identified, steps need to be taken to improve circumstances and avoid the cause of the skin breakdown completely. This should include appropriate repositioning, pressure relief and cushioning with continued observation to make sure no new areas of skin breakdown are developing.

In addition to identifying the cause and removing the forces causing this skin breakdown, a program for appropriate wound care dressing should be devised. This should include appropriate covering that would protect the wound and not allow it to dry out; appropriate cleansing to prevent overgrowth of bacteria; removal of dead or necrotic tissue; and stimulation for healing tissue and skin growth.

There are many preparations available and dressing change treatments that may be appropriate for individuals with their type of skin breakdown condition. It is most important that the wound is not allowed to dry out as this can cause death of the tissues and cells that have dried, resulting in necrotic non-viable material that needs to be removed to allow for appropriate healing to occur.

There are many factors which need to be considered for optimal wound healing:

Individuals often develop skin breakdown because of poor nutritional status that is also characterized by poor appetite, weight loss, and may likely be due to protein malnourishment. Nutritional supplements including vitamin supplements as well as protein are essential in most individuals for adequate wound healing.

Sometimes individuals who do receive adequate nutrition, however, are still unable to heal their wounds because of slowing of their metabolism that has occurred because of an anabolic imbalance of a person’s healing and general health and wellness. Because of this, I often prescribe anabolic steroid treatments to improve all these areas. This treatment shows good results in improving metabolism and results in excellent wound healing. It has been my experience that if a wound is identified early on in its course, an aggressive prescription of anabolic steroid treatment as well as nutritional supplements can be given. I have seen wounds heal significantly over the span of several weeks.

I do feel that the area of circulation - oxygen flow to the healing areas - is important. Of course this relates mostly to cigarette smoking and the affect that cigarette smoking or nicotine has on the tiny blood vessels that supply oxygen and nutrients to the wound for healing.

Sometimes the wound may have a foul odor and appear to have pus or infection draining from the wound. I do not typically prescribe antibiotics for topical use to be applied directly on the wound. A good dressing change to cleanse the area on a regular basis is most helpful. If there are signs of infection in the skin around the wound, I will prescribe an antibiotic by mouth.

There are other advancements in wound care that can improve likelihood of wound healing to occur. These can include electrical stimulation to enhance growth of the healing tissues and skin growth. Also electrical stimulation may be performed to improve circulation.

I feel that any individual with skin breakdown problems can have an organized approach to addressing all of these areas mentioned and multiple combined treatments for best response for wound healing to occur. The most important factor in continued skin health with good skin integrity is persistent reevaluation and examinations of the skin on a regular basis to identify any possible problems and to initiate rapid change in behavior or circumstances causing skin breakdown. This needs to be a way of life for individuals with spinal cord injury.