FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Pressure Ulcers in a Post Disaster Setting: Benefits of Advanced Wound Care Techniques
McNutt, J, Miller, J, Cherry, J, Eyssallenne, A
Hospital Bernard Mevs Project Medishare, Haiti, jbm911@hotmail.com
Introduction
On January 12, 2010 Haiti was rocked by a 7.0
magnitude earthquake just outside the capital city of
Port au Prince. Though the earthquake only lasted 35
seconds, approx 316,000 people died, 300,000 were
injured and 1,000,000 made homeless. This was
devastating to a country already mired in poverty, and
lack of advanced medical care. Many injuries required
patients to be non-mobile before definitive care could
be provided, while others were left with spinal cord
injuries [SCI], conditions that occurred secondary to
trauma even before the earthquake. Many of these
people were left lying on the dirt floors of their tents or
lying on hard cots in field hospitals with no pressure
relief capabilities. Multiple pressure ulcers of all
stages were created. Our presentation will discuss the
need for advanced wound care techniques, especially
following a disaster of this sort, types of techniques
used and examples of patients treated.
Methods
Here we present 2 case studies of patients (E and C)
treated at Hospital Bernard Mevs Project Medishare in
Port au Prince, Haiti. Both had spinal cord injuries and
sustained their wounds following periods of prolonged
immobility and inadequate care which included lack of
medical support, lack of pressure relieving surfaces
and poor nutritional intake.
At the time of admission to our service E (a 24 y/o
quadriplegic since March 2010) had a Grade 4 sacral
ulcer with comorbidities of systemic infection, severe
malnutrition and severe depression. She sustained her
wounds from sleeping on hard flooring.
C is a 40 year old paraplegic (since 2004) who
presented with multiple wounds (up to grade IV) on his
sacrum and lower limbs. He lost his home in the
earthquake and had moved to a tent where he slept on
the ground and had no pressure relieving surfaces. He
had comorbidities of severe anemia (Hg 4.4g/dL),
systemic infection and severe malnutrition on
admission to our hospital.
Both patients were treated with a combination of
surgery, silver dressings, KCI V.A.C. ® negative
pressure therapy, physical therapy, appropriate
pressure relief and nutritional supplementation during
their stay.
Results
Wound measurements
Patient Date Wound Size
E sacrum Oct 2010 13.5 x 6.6 x 3.5cm with
undermining
Apr 2011 Healed
C sacrum Oct 2010
13.4 x10.3 x11.0cm
Apr 2011
Healed with STSG
61
C (R Troch)
C (L Troch)
Oct 2010
Apr 2011
Oct 2010
April 2011
6.5 x 6.2 x 1.4cm
2x2cm
5.7 x 5.1 x >0.1cm
Healed
Discussion
Pressure ulcer prevention in SCI patients is a
challenge. Poor nutrition and inadequate pressure
relief surfaces, compounded with decreased personnel
to provide care to patients in need contribute to
formation of wounds. Our case studies illustrate the
need for advanced wound care in a post disaster
setting and show that provision of such services can
offer the opportunity for complete healing of severe
wounds. Due to the lack of pressure relief surfaces, it
is also extremely important to increase education level
in mobility and therapy techniques to prevent further
pressure ulcers.
It is well known that good nutrition is necessary for
wound healing. Patients in “first world countries” with
wounds frequently require special nutritional
interventions. This is even more important in “third
world” countries when even prior to a national disaster
there is widespread starvation and malnutrition.
Deficiencies in protein and essential vitamins weaken
collagen synthesis, cellular cohesion, and leave soft
tissue more susceptible to breakdown and infection
due to immunosupression. [1]
Use of KCI’s V.A.C. ® Negative pressure wound
system, silver dressings, pressure relieving
techniques, physical therapy and improved nutritional
support have either closed, or greatly improved the
status of the wounds of the presented patients.
Educating local staff and patients in turning schedules,
mobility, and proper nutrition will continue to help heal
current ulcers, and hopefully prevent new pressure
ulcers from forming.
Clinical relevance
We demonstrate herein that advanced wound care
techniques, proper nutrition, education and superior
support surfaces will improve success in wound
healing in resource poor settings.
Acknowledgements
We appreciate the help of the staff and administration
of Hospital Bernard Mevs, and Project Medishare, and
numerous volunteers from all over the world.
References
[1] Bryant R., Acute and Chronic Wounds. (Mosby-
Year Book Inc. 1992) p.115
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